The effects of lymph node dissection techniques on survival in stage I non-small cell lung cancer

Abstract

Background

This study aimed to evaluate the effect of lymph node dissection technique on survival outcomes in patients who underwent surgery for clinical stage I non-small cell lung cancer.

Methods

A total of 442 patients with stage I non-small cell lung cancer who underwent surgical resection at multiple centers between 2011 and 2022 were retrospectively analyzed. Patients were divided into two groups according to the lymph node dissection technique: lobe-specific lymph node dissection and systematic lymph node dissection. Survival outcomes and postoperative complications were compared between the groups. Multivariate Cox regression analysis was performed to identify prognostic factors affecting survival.

Results

Postoperative complications occurred in 86 patients (19.5%). Complications were significantly less frequent in the lobe-specific lymph node dissection group compared to the systematic lymph node dissection group (9.4% vs. 22.4%, respectively; p = 0.027). The overall annual survival rate was 68.3%. The 5-year survival rate was significantly higher in female patients than in male patients (83.6% vs. 61.7%, p < 0.001). The 5-year survival rate was 69.3% in patients who underwent systematic lymph node dissection and 64.8% in those who underwent lobe-specific lymph node dissection, with no statistically significant difference between the two techniques (p = 0.332). In multivariate Cox regression analysis, advanced age was not a significant predictor of survival (p = 0.119, HR = 0.714, 95% CI: 0.467–1.090), whereas male gender was identified as an independent poor prognostic factor (p = 0.01, HR = 2.781, 95% CI: 1.506–5.138).

Conclusions

Lymph node dissection remains a critical component of surgical treatment in early-stage lung cancer. The comparable survival outcomes and lower complication rates observed with lobe-specific lymph node dissection suggest that it may be a preferable option in selected patients with stage I non-small cell lung cancer. Nevertheless, prospective multicenter studies are required to confirm these findings.

Keywords

Lung cancer – surgical therapy < thoracic lung cancer – screening staging investigations < thoracic lung cancer diagnosis (includes staging imaging fiducials)mediastinum – other < thoracic Lung neoplasms thoracic neoplasms survival lymph nodes

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