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• W3018955722 abstract "There has been great progress in prognostic stratification since the advent of the eighth edition of the TNM staging system for lung cancer. Nevertheless, no consensus has been reached so far on the number of lymph nodes (LNs) evaluated during resection for stage I lung cancer. We thank Dr. Wo et al.1Dai J. Liu M. Yang Y. et al.Optimal lymph node examination and adjuvant chemotherapy for stage I lung cancer.J Thorac Oncol. 2019; 14: 1277-1285Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar for the positive feedback on our work and their comments on the differences in the evaluated LN number in previous population-based analyses. As reported by Dr. Wo and in our study, several optimal cutoff points in LN number have been proposed, ranging from 4 to 16, derived on the basis of various statistical models for prediction of stage migration and identification of survival benefit. The disparities in optimal LN examination among the studies could simply reflect the differences in inclusion criteria and model constructions, but more importantly, they could be owing to several inherent factors that were not captured by the published studies and databases, such as the Neighborhood Change Database and the Surveillance, Epidemiology, and End Results. First, most studies only incorporated tumor diameter and the main histopathologic type, whereas other tumor characteristics, for example, pathologic subtypes and the degree of differentiation, were not fully considered. In 2011, the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society jointly proposed a new adenocarcinoma classification, which not only indicates the invasive component of a tumor per se, but in addition implicates the strategic management of lung cancer. Adenocarcinomas that harbor micropapillary and solid pattern are reportedly more likely to have occult LN metastasis and benefit from adjuvant chemotherapy (AChT) even in their very early stages.2Tsao M.S. Marguet S. Le Teuff G. et al.Subtype classification of lung adenocarcinoma predicts benefit from adjuvant chemotherapy in patients undergoing complete resection.J Clin Oncol. 2015; 33: 3439-3446Crossref PubMed Scopus (193) Google Scholar Therefore, surgeons tend to perform a thorough LN dissection for accurate staging if micropapillary and/or solid subtypes are indicated on intraoperative frozen sections and offer adjuvant interventions to potentially decrease recurrence. Second, a patient’s physical condition could also influence the extent of LN examination and administration of AChT. A recent review by our group revealed that patients with chronic obstructive pulmonary disease were at a higher risk of postoperative pulmonary complications and chemotherapy-related hazardous effects.3Dai J. Yang P. Cox A. Jiang G. Lung cancer and chronic obstructive pulmonary disease: from a clinical perspective.Oncotarget. 2017; 8: 18513-18524Crossref PubMed Scopus (43) Google Scholar Furthermore, a patient’s performance status (PS) plays a part in selecting an optimal therapeutic intervention, and an adequate lymphadenectomy is more often performed in patients with good PS, as AChT may benefit those with good PS more than those with poor PS.4Howington J.A. Blum M.G. Chang A.C. et al.Treatment of stage I and II non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2013; 143: e278S-e313SAbstract Full Text Full Text PDF PubMed Scopus (896) Google Scholar Apart from these identifiable elements (i.e., intrinsic biological behavior of a tumor and the patient’s functional status), some environmental factors have been usually underappreciated, such as the pathologist’s and surgeon’s behaviors. The thoroughness of pathology practice could affect the number of studied intrapulmonary LNs and discovery of N1 nodal metastasis. Moreover, surgeons with moderate experience tend to have higher yield of evaluated LNs than those with low and high experience.5Scheel 3rd, P.R. Crabtree T.D. Bell J.M. et al.Does surgeon experience affect outcomes in pathologic stage I lung cancer?.J Thorac Cardiovasc Surg. 2015; 149: 998-1004Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Overall, the exact LN number may be biased by various confounding factors, but it is encouraging that the number of LNs evaluated has been increasing during the past decade, indicating an adherence to lung cancer surgical quality standards, which ultimately will improve the outcomes of this devastating disease. This study has been funded by The National Natural Science Foundation of the People’s Republic of China (Grant No. 81802260) and the Shanghai Rising-Star Program (Grant No. 19QA1407400)." @default.
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• W3018955722 title "Identifiable and Unidentifiable Factors Influencing Lymph Node Examination and Adjuvant Chemotherapy in Stage I Lung Cancer" @default.
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