The following is a summary of “Hierarchy of prognostic quality markers after curative-intent resection of stage IA non-small cell lung cancer,” published in the April 2023 issue of Oncology by Shao, et al.
Curative excision of stage IA NSCLC results in an estimated 65% 5-year disease-free survival. Most failed curative-intent treatments likely result from poor resection quality and individual variances in cancer biology. Researchers analyzed the risk related to indicators of surgical competence. Based on population-based study data, they compared the results of pathologic IA NSCLC resections performed from 2009 to 2021 using the Mid-South Quality of Surgical Resection cohort.
Referenced against the strict International Association for the Study of Lung Cancer complete (R0) resection, researchers assessed 8 quality benchmarks: wedge resection, resections with positive margins, non-examination of lymph nodes (LN) from anywhere (pNX), mediastinal (pNXmed), intrapulmonary, hilar, low paratracheal, and subcarinal stations. Adjusted for age, sex, insurance, histology, comorbidities, preoperative staging, and resection technique, researchers analyzed the hazard ratios (HR) from Proportional Hazards models and their 95% CI.
Just 906 (41%) of the 2,243 resections were classified as R0, while the remaining 1,333 were classified as either R1, R2, pNX, wedge resections, pNXmed, 45% without subcarinal, 41% without hilar, 47% without low paratracheal, and 36% without intrapulmonary LNs. Adjusted HRs were as follows when comparing R1/R2 to IASLC-R0: 2.04 (95% CI: 1.21-3.44); 1.75 (95% CI: 1.33-2.31); 1.64 (95% CI: 1.26-2.14); 1.35 (95% CI: 1.12-1.63); 1.33 (1.03-1.72) for pNXmed; 1.25 (1.02-1.53) for non-examination of hilar LN; 1. Using measures of LN assessment to select or stratify patients for lung cancer surgery studies is warranted because of the substantial influence surgical quality has on long-term survival.
Source: abstractsonline.com/pp8/#!/10828/presentation/1539
