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. |
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| 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] |
| Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
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| Header | DbId: egs DbLabel: Engineering Source An: 154338718 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Comparison of National Comprehensive Cancer Network and American College of Surgeons Commission on Cancer Lymph Node Sampling Guidelines for Non-Small Cell Lung Cancer. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Heiden%2C+B%2E%22">Heiden, B.</searchLink><relatesTo>1,2</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Eaton%2C+D%2E%22">Eaton, D.</searchLink><relatesTo>3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chang%2C+S%2EH%2E%22">Chang, S.H.</searchLink><relatesTo>2,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Yan%2C+Y%2E%22">Yan, Y.</searchLink><relatesTo>2,3</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Schoen%2C+M%2E%22">Schoen, M.</searchLink><relatesTo>3,4</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Meyers%2C+B%2E%22">Meyers, B.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kozower%2C+B%2E%22">Kozower, B.</searchLink><relatesTo>1</relatesTo> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Puri%2C+V%2E%22">Puri, V.</searchLink><relatesTo>1,3</relatesTo> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics%22">International Journal of Radiation Oncology, Biology, Physics</searchLink>. Feb2022, Vol. 112 Issue 2, pe6-e6. 1p. – Name: Subject Label: Subjects Group: Su Data: <searchLink fieldCode="DE" term="%22National+Comprehensive+Cancer+Network+%28U%2ES%2E%29%22">National Comprehensive Cancer Network (U.S.)</searchLink><br /><searchLink fieldCode="DE" term="%22American+College+of+Surgeons%22">American College of Surgeons</searchLink><br /><searchLink fieldCode="DE" term="%22Non-small-cell+lung+carcinoma%22">Non-small-cell lung carcinoma</searchLink><br /><searchLink fieldCode="DE" term="%22Lymph+node+cancer%22">Lymph node cancer</searchLink><br /><searchLink fieldCode="DE" term="%22United+States%2E+Veterans+Health+Administration%22">United States. Veterans Health Administration</searchLink><br /><searchLink fieldCode="DE" term="%22Lymph+nodes%22">Lymph nodes</searchLink><br /><searchLink fieldCode="DE" term="%22Tumor+classification%22">Tumor classification</searchLink><br /><searchLink fieldCode="DE" term="%22Progression-free+survival%22">Progression-free survival</searchLink><br /><searchLink fieldCode="DE" term="%22Mediterranean+diet%22">Mediterranean diet</searchLink> – Name: Abstract Label: Abstract Group: Ab Data: 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] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1016/j.ijrobp.2021.10.171 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 1 StartPage: e6 Subjects: – SubjectFull: National Comprehensive Cancer Network (U.S.) Type: general – SubjectFull: American College of Surgeons Type: general – SubjectFull: Non-small-cell lung carcinoma Type: general – SubjectFull: Lymph node cancer Type: general – SubjectFull: United States. Veterans Health Administration Type: general – SubjectFull: Lymph nodes Type: general – SubjectFull: Tumor classification Type: general – SubjectFull: Progression-free survival Type: general – SubjectFull: Mediterranean diet Type: general Titles: – TitleFull: Comparison of National Comprehensive Cancer Network and American College of Surgeons Commission on Cancer Lymph Node Sampling Guidelines for Non-Small Cell Lung Cancer. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Heiden, B. – PersonEntity: Name: NameFull: Eaton, D. – PersonEntity: Name: NameFull: Chang, S.H. – PersonEntity: Name: NameFull: Yan, Y. – PersonEntity: Name: NameFull: Schoen, M. – PersonEntity: Name: NameFull: Meyers, B. – PersonEntity: Name: NameFull: Kozower, B. – PersonEntity: Name: NameFull: Puri, V. IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 02 Text: Feb2022 Type: published Y: 2022 Identifiers: – Type: issn-print Value: 03603016 Numbering: – Type: volume Value: 112 – Type: issue Value: 2 Titles: – TitleFull: International Journal of Radiation Oncology, Biology, Physics Type: main |
| ResultId | 1 |
