@article{f032e4bc3d034f788f409fe76435867a,
title = "Assessment of Updated Commission on Cancer Guidelines for Intraoperative Lymph Node Sampling in Early Stage NSCLC",
abstract = "Introduction: The American College of Surgeons Commission on Cancer recently updated its sampling recommendations for early stage NSCLC from at least 10 lymph nodes to at least one N1 (hilar) and three N2 (mediastinal) lymph node stations. Nevertheless, intraoperative lymph node sampling minimums remain subject to debate. We sought to evaluate these guidelines in patients with early stage NSCLC. Methods: We performed a cohort study using a uniquely compiled data set from the Veterans Health Administration. We manually abstracted data from operative notes and pathology reports of patients with clinical stage I NSCLC receiving surgery (2006–2016). Adequacy of lymph node sampling was defined using count-based (≥10 lymph nodes) and station-based (≥three N2 and one N1 nodal stations) minimums. Our primary outcome was recurrence-free survival. Secondary outcomes were overall survival and pathologic upstaging. Results: The study included 9749 patients. Count-based and station-based sampling guidelines were achieved in 3302 (33.9%) and 2559 patients (26.3%), respectively, with adherence to either sampling guideline increasing over time from 35.6% (2006) to 49.1% (2016). Adherence to station-based sampling was associated with improved recurrence-free survival (multivariable-adjusted hazard ratio = 0.815, 95% confidence interval: 0.667–0.994, p = 0.04), whereas adherence to count-based sampling was not (adjusted hazard ratio = 0.904, 95% confidence interval: 0.757–1.078, p = 0.26). Adherence to either station-based or count-based guidelines was associated with improved overall survival and higher likelihood of pathologic upstaging. Conclusions: Our study supports station-based sampling minimums (≥three N2 and one N1 nodal stations) for early stage NSCLC; however, the marginal benefit compared with count-based guidelines is minimal. Further efforts to promote widespread adherence to intraoperative lymph node sampling minimums are critical for improving patient outcomes after curative-intent lung cancer resection.",
keywords = "Lymph node sampling, Non–small cell lung cancer, Quality metrics, Surgery",
author = "Heiden, {Brendan T.} and Eaton, {Daniel B.} and Chang, {Su Hsin} and Yan Yan and Schoen, {Martin W.} and Patel, {Mayank R.} and Daniel Kreisel and Nava, {Ruben G.} and Meyers, {Bryan F.} and Kozower, {Benjamin D.} and Varun Puri",
note = "Funding Information: This work was supported by Merit Award # 1I01HX002475-01A2 from the U.S. Department of Veterans Affairs (VP, SHC, YY, DBE) and 5T32HL007776-25 from the National Institutes of Health (BTH). Funded in part by NIH 5T32HL007776-25 (BTH), 1 I01 HX002475-01A2 (VP, S-HC, YY). The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government. This cohort study required extensive data acquisition, biostatistical, and technical review. Our team consists of five attending surgeons from Washington University School of Medicine, three attending surgeons from the St. Louis VA Hospital (including two with dual appointments at Washington University), a medical oncologist at the St. Louis VA Hospital (dual appointment at St. Louis University School of Medicine), three biostatisticians (at Washington University and St. Louis VA Hospital), and a general surgery resident. Funding Information: This work was supported by Merit Award # 1I01HX002475-01A2 from the U.S. Department of Veterans Affairs (VP, SHC, YY, DBE) and 5T32HL007776-25 from the National Institutes of Health (BTH). Funded in part by NIH 5T32HL007776-25 (BTH), 1 I01 HX002475-01A2 (VP, S-HC, YY). The contents do not represent the views of the U.S. Department of Veterans Affairs or the U.S. Government. This cohort study required extensive data acquisition, biostatistical, and technical review. Our team consists of five attending surgeons from Washington University School of Medicine, three attending surgeons from the St. Louis VA Hospital (including two with dual appointments at Washington University), a medical oncologist at the St. Louis VA Hospital (dual appointment at St. Louis University School of Medicine), three biostatisticians (at Washington University and St. Louis VA Hospital), and a general surgery resident. Publisher Copyright: {\textcopyright} 2022 International Association for the Study of Lung Cancer",
year = "2022",
month = nov,
doi = "10.1016/j.jtho.2022.08.009",
language = "English",
volume = "17",
pages = "1287--1296",
journal = "Journal of Thoracic Oncology",
issn = "1556-0864",
number = "11",
}