Risk-adapted nodal evaluation in stage IA non-small cell lung cancer: a population-based competing-risk analysis.

IF 2.8 3区医学 Q3 ONCOLOGY

World Journal of Surgical Oncology Pub Date : 2026-07-01 DOI:10.1186/s12957-026-04485-2

Ziqiang Wang, Yangyang Xie, Tingting Wang, Xue Song, Nian Liu

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Abstract

Background: The oncologic value of intensified lymph node (LN) evaluation in stage IA non-small cell lung cancer (NSCLC) remains uncertain in the era of surgical de-escalation. Although expanded nodal assessment may reduce understaging, whether it is associated with meaningful survival differences in this favorable-risk population is unclear. Clarifying this issue is essential to balance oncologic adequacy and surgical burden.

Method: We conducted a population-based cohort study using the Surveillance, Epidemiology, and End Results database and included patients with surgically treated pathologic stage IA (T1N0M0) NSCLC. The extent of nodal evaluation was quantified by the number of examined lymph nodes. Propensity score matching was used to balance baseline characteristics. Cancer-specific and other-cause death were analyzed using cumulative incidence functions and Fine-Gray competing-risk models. Prespecified subgroup analyses assessed heterogeneity of association, particularly according to tumor size.

Results: We included 24,215 patients, with 13,812 after matching. Intensified nodal evaluation, defined as ≥ 6 examined lymph nodes (ELNs), was associated with lower cancer-specific mortality (5-year cumulative incidence, 12.9% vs. 15.3%; absolute risk reduction [ARR] 2.4%; Gray's P < 0.001). In multivariable Fine-Gray analysis, ELNs ≥ 6 remained independently associated with lower cancer-specific mortality (subdistribution hazard ratio 0.78, 95% CI 0.74-0.83). The association was minimal in tumors ≤ 1 cm but more evident in tumors > 1 cm. Sensitivity analyses using ELNs ≥ 10 yielded similar findings.

Conclusion: The association between intensified nodal evaluation and lower cancer-specific mortality in stage IA NSCLC varies by tumor size. This association was more evident in tumors > 1 cm, supporting further investigation of a size-based, risk-adapted approach to surgical staging in early-stage NSCLC.

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IA期非小细胞肺癌的风险适应淋巴结评估：基于人群的竞争风险分析

背景：在手术降压时代，强化淋巴结（LN）评估在IA期非小细胞肺癌（NSCLC）中的肿瘤学价值仍不确定。虽然扩大淋巴结评估可能会减少分期不足，但在这种有利风险人群中是否与有意义的生存差异有关尚不清楚。澄清这一问题对于平衡肿瘤充分性和手术负担至关重要。方法：我们使用监测、流行病学和最终结果数据库进行了一项基于人群的队列研究，纳入了手术治疗的病理期IA (T1N0M0) NSCLC患者。通过检查的淋巴结数量来量化淋巴结评估的程度。倾向评分匹配用于平衡基线特征。使用累积发生率函数和Fine-Gray竞争风险模型分析癌症特异性死亡和其他原因死亡。预先指定的亚组分析评估了相关性的异质性，特别是根据肿瘤大小。结果：纳入24215例患者，配对后纳入13812例。强化淋巴结评估，定义为≥6个检查的淋巴结（eln），与较低的癌症特异性死亡率相关（5年累积发病率，12.9% vs. 15.3%；绝对风险降低[ARR] 2.4%; Gray's P 1 cm）。使用eln≥10的敏感性分析也得出了类似的结果。结论：在IA期非小细胞肺癌中，强化淋巴结评估与降低肿瘤特异性死亡率之间的关系因肿瘤大小而异。这种关联在直径为10 ~ 1cm的肿瘤中更为明显，支持进一步研究基于大小、风险适应的早期非小细胞肺癌手术分期方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Surgical Oncology ONCOLOGY-SURGERY

CiteScore

4.70

自引率

15.60%

发文量

362

审稿时长

3 months

期刊介绍： World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics. Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.