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Comparison of National Comprehensive Cancer Network and American College of Surgeons Commission on Cancer Lymph Node Sampling Guidelines for Non-Small Cell Lung Cancer.

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Title: Comparison of National Comprehensive Cancer Network and American College of Surgeons Commission on Cancer Lymph Node Sampling Guidelines for Non-Small Cell Lung Cancer.
Authors: Heiden, B.1,2 (AUTHOR), Eaton, D.3 (AUTHOR), Chang, S.H.2,3 (AUTHOR), Yan, Y.2,3 (AUTHOR), Schoen, M.3,4 (AUTHOR), Meyers, B.1 (AUTHOR), Kozower, B.1 (AUTHOR), Puri, V.1,3 (AUTHOR)
Source: International Journal of Radiation Oncology, Biology, Physics. Feb2022, Vol. 112 Issue 2, pe6-e6. 1p.
Subjects: National Comprehensive Cancer Network (U.S.), American College of Surgeons, Non-small-cell lung carcinoma, Lymph node cancer, United States. Veterans Health Administration, Lymph nodes, Tumor classification, Progression-free survival, Mediterranean diet
Abstract: Current guidelines conflict regarding adequate lymph node sampling during lung cancer surgery. The National Comprehensive Cancer Network (NCCN) guidelines recommend sampling at least 3 N2 and 1 N1 stations while the American College of Surgeons Commission on Cancer (CoC) guidelines recommend sampling at least 10 total lymph nodes. We sought to compare these guidelines in a cohort of Veterans with clinical stage I non-small cell lung cancer (NSCLC). We performed a retrospective cohort study using a uniquely compiled dataset from the Veterans Health Administration (VHA) consisting of adults with clinical stage I NSCLC receiving surgery (2006-2016). We assembled a team of researchers who extracted lymph node sampling information from pathology reports and operative notes over a period in excess of 20 months. We defined sampling adequacy based on current guidelines from the NCCN (≥3 N2 + 1 N1 station) and CoC (≥10 lymph nodes). Our primary outcomes of interest were pathologic upstaging, disease-free survival, and overall survival. A total of 9575 patients were included in the current study. Of these, 3556 (37.1%) patients met NCCN guidelines and 3250 (33.9%) patients met CoC guidelines. Upstaging was observed in 1236 (12.9%) individuals. Adherence to either NCCN (adjusted odds ratio [aOR] 1.299, 95% CI 1.130-1.492) or CoC (aOR 1.637, 95% CI 1.425-1.881) guidelines was associated with higher likelihood of upstaging. With a median follow-up of 6.14 years, recurrence was observed in 2260 (23.6%) patients. While adherence to NCCN guidelines was associated with lower risk of recurrence (adjusted hazard ratio [aHR] 0.867, 95% CI 0.785-0.958), adherence to CoC guidelines was not associated with disease recurrence (aHR 0.928, 95% CI 0.839-1.028). Adherence to NCCN (aHR 0.932, 95% CI 0.874-0.994) or CoC (aHR 0.931, 95% CI 0.871-0.996) guidelines were associated with improved overall survival. These data suggest that adherence to NCCN sampling guidelines may mitigate the risk of recurrence in clinical stage I NSCLC. Improving adherence to either guideline, however, may significantly improve long-term survival in patients with clinical stage I NSCLC undergoing surgical treatment. [ABSTRACT FROM AUTHOR]
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Abstract:Current guidelines conflict regarding adequate lymph node sampling during lung cancer surgery. The National Comprehensive Cancer Network (NCCN) guidelines recommend sampling at least 3 N2 and 1 N1 stations while the American College of Surgeons Commission on Cancer (CoC) guidelines recommend sampling at least 10 total lymph nodes. We sought to compare these guidelines in a cohort of Veterans with clinical stage I non-small cell lung cancer (NSCLC). We performed a retrospective cohort study using a uniquely compiled dataset from the Veterans Health Administration (VHA) consisting of adults with clinical stage I NSCLC receiving surgery (2006-2016). We assembled a team of researchers who extracted lymph node sampling information from pathology reports and operative notes over a period in excess of 20 months. We defined sampling adequacy based on current guidelines from the NCCN (≥3 N2 + 1 N1 station) and CoC (≥10 lymph nodes). Our primary outcomes of interest were pathologic upstaging, disease-free survival, and overall survival. A total of 9575 patients were included in the current study. Of these, 3556 (37.1%) patients met NCCN guidelines and 3250 (33.9%) patients met CoC guidelines. Upstaging was observed in 1236 (12.9%) individuals. Adherence to either NCCN (adjusted odds ratio [aOR] 1.299, 95% CI 1.130-1.492) or CoC (aOR 1.637, 95% CI 1.425-1.881) guidelines was associated with higher likelihood of upstaging. With a median follow-up of 6.14 years, recurrence was observed in 2260 (23.6%) patients. While adherence to NCCN guidelines was associated with lower risk of recurrence (adjusted hazard ratio [aHR] 0.867, 95% CI 0.785-0.958), adherence to CoC guidelines was not associated with disease recurrence (aHR 0.928, 95% CI 0.839-1.028). Adherence to NCCN (aHR 0.932, 95% CI 0.874-0.994) or CoC (aHR 0.931, 95% CI 0.871-0.996) guidelines were associated with improved overall survival. These data suggest that adherence to NCCN sampling guidelines may mitigate the risk of recurrence in clinical stage I NSCLC. Improving adherence to either guideline, however, may significantly improve long-term survival in patients with clinical stage I NSCLC undergoing surgical treatment. [ABSTRACT FROM AUTHOR]
ISSN:03603016
DOI:10.1016/j.ijrobp.2021.10.171