Should Sampling of Three N2 Stations be a Quality Metric for Curative Resection of Stage I Lung Cancer?
Academic Article
Overview
abstract
OBJECTIVE: In 2022, ACS Commission on Cancer (CoC) issued standard 5.8 quality metric for curative lung cancer resections requiring nodal resection from 3 N2 stations. In this report we compare oncologic outcomes following resection of 3 N2 stations versus 2 N2 stations in stage I NSCLC. METHODS: A retrospective review from a single institution database was conducted from 2011-2020 to identify patients with clinical stage I NSCLC. Patients with history of lung cancer, carcinoid tumors, ground glass lesions <50% solid component were excluded. Primary outcome was overall survival (OS). Secondary outcomes included disease-free survival (DFS), recurrence patterns, and nodal upstaging. RESULTS: 581 patients were identified and divided into two groups based on number of N2 stations examined; Group A had 2 N2 stations examined (364 patients) and group B had ≥3 N2 stations examined (217 patients). Baseline demographic and clinical characteristics were similar between groups. In Group A, N1 and N2 positive nodal stations were present in 8.2% (30/364) and 5.2% (19/364) of patients versus 7.4% (16/217) and 5.5% (12/217) respectively in Group B. 5- year OS and DFS were 89% and 74% in Group A versus 88% and 78% in Group B respectively. Recurrence occurred in 56 patients (15.4%) in Group A (6.6% local and 8.8% distant) and 29 patients (13.4%) in Group B (5.1% local and 8.3% distant; p = 0.73). CONCLUSION: There was no significant difference in oncological outcomes in stage I NSCLC resections that included 2 N2 stations compared to at least 3 N2 stations examined.
