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Junye Wang
Sun Yat-sen University Cancer Center
Corresponding Author
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Background The examination of lymph nodes (LNs) plays an important role in the nodal staging of non-small cell lung cancer (NSCLC). For patients without LN metastasis, the main role of thorough LN examination is accurate staging, which weakens the effect of staging migration. To date, on the role of hilar and intrapulmonary (N1) station LNs has not been fully appreciated. In this study, we aimed to confirm the significance of N1 LNs in long-term survival for stage IA-IIA NSCLC patients and to find the minimum number of LN to examine.
Methods The data of patients who underwent radical lobectomy and were confirmed as having nonmetastatic LNs from January 2008 to March 2018 were retrospectively screened. Pathology records were reviewed for the number of LNs examined. The Kaplan-Meier method and Cox regression model were used to identify survival and prognostic factors.
Results The median number of resected N1 LNs was 8. The number of patients with 0-2 N1 LNs, 3-5 N1 LNs, 6-8 N1 LNs, 9-11 N1 LNs and more than 11 N1 LNs examined was 181, 425, 477, 414 and 531, respectively. Sex (P=0.004), age (P<0.001), tumor size (P=0.004), differentiation degree (P=0.001) and number of N1 LNs examined (P=0.008) were independent prognostic factors of overall survival. Gender (P=0.006), age (P=0.031), tumor size (P=0.001), differentiation degree (P=0.001), vascular invasion (P=0.034) and number of N1 LNs examined (P=0.007) were independent prognostic factors of disease-free survival.
Conclusion Increasing the number of N1 LNs examination might improve the long-term survival of T1-2N0 NSCLC patients. These data indicate that the optimal practice involves examining at least 6 N1 nodes in surgical and pathological management but cannot prove this. This finding should be confirmed in a large, prospective randomized clinical study.
Keywords
non-small cell lung cancer, lymph node, prognosis
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CURRENT STATUS: Published
View the published article at World Journal of Surgical Oncology.
No community comments so far
Review #2 received
Received 09 Sep, 2020
Editorial decision: Accept
On 09 Sep, 2020
Reviewer #2 agreed
On 01 Sep, 2020
Editor assigned
On 31 Aug, 2020
Reviewers invited
Invitations sent on 31 Aug, 2020
Reviewer #1 agreed
On 31 Aug, 2020
Review #1 received
Received 31 Aug, 2020
Submission checks complete
On 30 Aug, 2020
Editor invited
On 30 Aug, 2020
Version 2
Posted 20 Jul, 2020
No comments provided
Editorial decision: Major Revision
On 03 Aug, 2020
Review #5 received
Received 02 Aug, 2020
Review #4 received
Received 01 Aug, 2020
Review #3 received
Received 29 Jul, 2020
Reviewer #5 agreed
On 26 Jul, 2020
Reviewer #4 agreed
On 25 Jul, 2020
Reviewer #3 agreed
On 24 Jul, 2020
Reviewer #2 agreed
On 23 Jul, 2020
Review #2 received
Received 23 Jul, 2020
Reviewers invited
Invitations sent on 14 Jul, 2020
Reviewer #1 agreed
On 14 Jul, 2020
Review #1 received
Received 14 Jul, 2020
Editor assigned
On 13 Jul, 2020
Submission checks complete
On 12 Jul, 2020
Editor invited
On 12 Jul, 2020
No comments provided
Editorial decision: Major Revision
On 16 Jun, 2020
Review #2 received
Received 03 Jun, 2020
Review #3 received
Received 03 Jun, 2020
Reviewer #3 agreed
On 01 Jun, 2020
Review #1 received
Received 31 May, 2020
Reviewer #2 agreed
On 29 May, 2020
Reviewer #1 agreed
On 14 May, 2020
Reviewers invited
Invitations sent on 23 Apr, 2020
Editor assigned
On 21 Apr, 2020
First submitted
On 20 Apr, 2020
Submission checks complete
On 20 Apr, 2020
Editor invited
On 20 Apr, 2020
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at World Journal of Surgical Oncology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Junye Wang
Sun Yat-sen University Cancer Center
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at World Journal of Surgical Oncology.
No community comments so far
Review #2 received
Received 09 Sep, 2020
Editorial decision: Accept
On 09 Sep, 2020
Reviewer #2 agreed
On 01 Sep, 2020
Editor assigned
On 31 Aug, 2020
Reviewers invited
Invitations sent on 31 Aug, 2020
Reviewer #1 agreed
On 31 Aug, 2020
Review #1 received
Received 31 Aug, 2020
Submission checks complete
On 30 Aug, 2020
Editor invited
On 30 Aug, 2020
Version 2
Posted 20 Jul, 2020
No comments provided
Editorial decision: Major Revision
On 03 Aug, 2020
Review #5 received
Received 02 Aug, 2020
Review #4 received
Received 01 Aug, 2020
Review #3 received
Received 29 Jul, 2020
Reviewer #5 agreed
On 26 Jul, 2020
Reviewer #4 agreed
On 25 Jul, 2020
Reviewer #3 agreed
On 24 Jul, 2020
Reviewer #2 agreed
On 23 Jul, 2020
Review #2 received
Received 23 Jul, 2020
Reviewers invited
Invitations sent on 14 Jul, 2020
Reviewer #1 agreed
On 14 Jul, 2020
Review #1 received
Received 14 Jul, 2020
Editor assigned
On 13 Jul, 2020
Submission checks complete
On 12 Jul, 2020
Editor invited
On 12 Jul, 2020
No comments provided
Editorial decision: Major Revision
On 16 Jun, 2020
Review #2 received
Received 03 Jun, 2020
Review #3 received
Received 03 Jun, 2020
Reviewer #3 agreed
On 01 Jun, 2020
Review #1 received
Received 31 May, 2020
Reviewer #2 agreed
On 29 May, 2020
Reviewer #1 agreed
On 14 May, 2020
Reviewers invited
Invitations sent on 23 Apr, 2020
Editor assigned
On 21 Apr, 2020
First submitted
On 20 Apr, 2020
Submission checks complete
On 20 Apr, 2020
Editor invited
On 20 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at World Journal of Surgical Oncology.
Background The examination of lymph nodes (LNs) plays an important role in the nodal staging of non-small cell lung cancer (NSCLC). For patients without LN metastasis, the main role of thorough LN examination is accurate staging, which weakens the effect of staging migration. To date, on the role of hilar and intrapulmonary (N1) station LNs has not been fully appreciated. In this study, we aimed to confirm the significance of N1 LNs in long-term survival for stage IA-IIA NSCLC patients and to find the minimum number of LN to examine.
Methods The data of patients who underwent radical lobectomy and were confirmed as having nonmetastatic LNs from January 2008 to March 2018 were retrospectively screened. Pathology records were reviewed for the number of LNs examined. The Kaplan-Meier method and Cox regression model were used to identify survival and prognostic factors.
Results The median number of resected N1 LNs was 8. The number of patients with 0-2 N1 LNs, 3-5 N1 LNs, 6-8 N1 LNs, 9-11 N1 LNs and more than 11 N1 LNs examined was 181, 425, 477, 414 and 531, respectively. Sex (P=0.004), age (P<0.001), tumor size (P=0.004), differentiation degree (P=0.001) and number of N1 LNs examined (P=0.008) were independent prognostic factors of overall survival. Gender (P=0.006), age (P=0.031), tumor size (P=0.001), differentiation degree (P=0.001), vascular invasion (P=0.034) and number of N1 LNs examined (P=0.007) were independent prognostic factors of disease-free survival.
Conclusion Increasing the number of N1 LNs examination might improve the long-term survival of T1-2N0 NSCLC patients. These data indicate that the optimal practice involves examining at least 6 N1 nodes in surgical and pathological management but cannot prove this. This finding should be confirmed in a large, prospective randomized clinical study.
Figure 1
Figure 2
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