Efficacy and safety of different methods of lymphadenectomy for early stage non-small-cell lung cancer: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

JING Tao ¹ ^# , YANG Jianbao ¹ ^# , FENG Haiming ¹ , MA Jianxing ¹ , BAI Zhenggang ² ,  WANG Cheng ¹

1. The Second Hospital & the Second Clinical Medicine College of Lanzhou University, Lanzhou, 730000, P.R.China;
2. Evidence-Based Medicine Center, Lanzhou University, Lanzhou, 730000, P.R.China;

Corresponding author：

WANG Cheng, Email: wangchengxw@aliyun.com

Keywords：

Non-small cell lung cancer; Systemic mediastinal lymph node dissection; Lymph node-sampling; Lobe-specific lymph node dissection; Meta-analysis; Systematic review; Randomized controlled trial; Non-randomized controlled study

DOI：

10.7507/1672-2531.201704059

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objectives To systematically review the efficacy and safety of non-systemic lymph dissection (NSMLD) vs. systemic lymph dissection (SMLD) for early stage non-small cell lung cancer (NSCLC). Methods PubMed, EMbase, Web of Science and The Cochrane Library databases were searched online to collect randomized controlled trials (RCTs) and non-randomized controlled studies (NRCTs) of NSMLD vs. SMLD for NSCLC patients from inception to October, 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 16 studies (4 RCTs and 12 NRCTs) involving 4 718 patients were included. The results of meta-analysis showed that: Compared with the SMLD group, the NSMLD group had higher mortality (HR=1.23, 95%CI 1.11 to 1.37, P<0.000 1). There were no significant differences in disease-free survival, local recurrence rate, distant metastasis rate, and safety between two groups. In addition, the NSMLD group had shorter operation time, and lower drainage and blood loss. Subgroup analysis was performed according to operation methods. The results showed that: NSMLD group by lymph node sampling (LN-S) had higher mortality than SMLD group (HR=1.43, 95%CI 1.17 to 1.75,P=0.004), NSMLD group by lobe-specific lymph node dissection (L-SLD) did not have higher mortality. Conclusions Current evidence shows that: compared with SMLD, NSMLD by L-SLD do not have higher mortality in early stage NSCLC patients, while NSMLD by LN-S have higher mortality. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusion.

Citation： JING Tao, YANG Jianbao, FENG Haiming, MA Jianxing, BAI Zhenggang, WANG Cheng. Efficacy and safety of different methods of lymphadenectomy for early stage non-small-cell lung cancer: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2018, 18(1): 43-51. doi: 10.7507/1672-2531.201704059 Copy

1.	陈万青, 张思维, 邹小农. 中国肺癌发病死亡的估计和流行趋势研究. 中国肺癌杂志, 2010, 13(5): 488-493.
2.	Darling GE, Maziak DE, Inculet RI, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. Thorac Oncol, 2011, 6(8): 1367-1372.
3.	Verhagen AF, Bulten J, Shirango H, et al. The clinical value of lymphatic micrometastases in patients with non-small cell lung cancer. Thorac Oncol, 2010, 5(8): 1201-1205.
4.	Yue D, Gong L, You J, et al. Survival analysis of patients with non-small cell lung cancer who underwent surgical resection following 4 lung cancer resection guidelines. BMC Cancer, 2014, 14(1): 1-9.
5.	Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8(1): 16.
6.	Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343(2): 5928.
7.	Wells GA, Shea BJ, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Engin Agricul, 2014, 18(6): 727-734.
8.	Ma W, Zhang ZJ, Li Y, et al. Comparison of lobe-specific mediastinal lymphadenectomy versus systematic mediastinal lymphadenectomy for clinical stage T(1)a N(0) M(0) non-small cell lung cancer. J Cancer Res Ther, 2013, Suppl2(5): 101-105.
9.	Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American college of surgery oncology group Z0030 Trial. Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
10.	Wu Y, Huang ZF, Wang SY, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
11.	Sugi K, Nawata K, Fujita N, et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg, 1998, 22(3): 290-294.
12.	Wang Y, Wu N, Chen J, et al. Is radical mediastinal lymphadenectomy necessary for elderly patients with clinical N-negative non-small-cell lung cancer? A single center matched-pair study. J Surg Res, 2015, 193(1): 435-441.
13.	Wu N, Yan S, Lv C, et al. Does an extended mediastinal lymphadenectomy improve outcome after R0 resection in lung cancer? Chin J Cancer Res, 2014, 26(2): 183-191.
14.	Jeon HW, Moon MH, Kim KS, et al. Extent of removal for mediastinal nodal stations for patients with clinical stage I non-small cell lung cancer: effect on outcome. Thorac Cardiovasc Surg, 2014, 62(7): 599-604.
15.	Shapiro M, Kadakia S, Lim J, et al. Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer. Chest, 2013, 144(5): 1615-1621.
16.	Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2013, 44(1): 59-64.
17.	Jiang W, Chen X, Xi J, et al. Selective mediastinal lymphadenectomy without intraoperative frozen section examinations for clinical stage I non-small-cell lung cancer: retrospective study of 403 cases. World J Surg, 2013, 37(2): 392-397.
18.	Takizawa H, Kondo K, Matsuoka H, et al. Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer. J Med Invest, 2008, 55(1-2): 37-43.
19.	Su X, Wang X, Long H, et al. Mediastinal lymph node dissection affects survival in patients with stage I non-small cell lung cancer. Thorac Cardiovasc Surg, 2008, 56(4): 226-230.
20.	Ma K, Chang D, He B, et al. Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer. J Cancer Res Clin Oncol, 2008, 134(12): 1289-1295.
21.	Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer. Ann Thorac Surg, 2006, 81(3): 1028-1032.
22.	Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1): 268-274.
23.	Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
24.	Oda M, Watanabe Y, Shimizu J, et al. Extent of mediastinal node metastasis in clinical stage I non-small-cell lung cancer: the role of systematic nodal dissection. Lung Cancer, 1998, 22(1): 23-30.
25.	Bollen EC, van Duin CJ, Theunissen PH, et al. Mediastinal lymph node dissection in resected lung cancer: morbidity and accuracy of staging. Ann Thorac Surg, 1993, 55(4): 961-966.
26.	Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
27.	Wu J, Ohta Y, Minato H, et al. Nodal occult metastasis in patients with peripheral lung adenocarcinoma of 2.0cm or less in diameter. Ann Thorac Surg, 2001, 71(6): 1772-1777.
28.	Gu CD, Osaki T, Oyama T, et al. Detection of micrometastatic tumor cells in pN0 lymph nodes of patients with completely resected nonsmall cell lung cancer: impact on recurrence and Survival. Ann Surg, 2002, 235(1): 133-139.
29.	Gajra A, Newman N, Gamble GP, et al. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J Clin Oncol, 2003, 21(6): 1029-1034.
30.	Okada M, Tsubota N, Yoshimura M, et al. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg, 1999, 118(2): 270-275.
31.	Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
32.	Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg, 2010, 139(4): 1001-1006.
33.	Huang X, Wang J, Chen Q, et al. Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS One, 2014, 9(10): 109979.

1. 陈万青, 张思维, 邹小农. 中国肺癌发病死亡的估计和流行趋势研究. 中国肺癌杂志, 2010, 13(5): 488-493.
2. Darling GE, Maziak DE, Inculet RI, et al. Positron emission tomography-computed tomography compared with invasive mediastinal staging in non-small cell lung cancer: results of mediastinal staging in the early lung positron emission tomography trial. Thorac Oncol, 2011, 6(8): 1367-1372.
3. Verhagen AF, Bulten J, Shirango H, et al. The clinical value of lymphatic micrometastases in patients with non-small cell lung cancer. Thorac Oncol, 2010, 5(8): 1201-1205.
4. Yue D, Gong L, You J, et al. Survival analysis of patients with non-small cell lung cancer who underwent surgical resection following 4 lung cancer resection guidelines. BMC Cancer, 2014, 14(1): 1-9.
5. Tierney JF, Stewart LA, Ghersi D, et al. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials, 2007, 8(1): 16.
6. Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 2011, 343(2): 5928.
7. Wells GA, Shea BJ, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Appl Engin Agricul, 2014, 18(6): 727-734.
8. Ma W, Zhang ZJ, Li Y, et al. Comparison of lobe-specific mediastinal lymphadenectomy versus systematic mediastinal lymphadenectomy for clinical stage T(1)a N(0) M(0) non-small cell lung cancer. J Cancer Res Ther, 2013, Suppl2(5): 101-105.
9. Darling GE, Allen MS, Decker PA, et al. Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell carcinoma: results of the American college of surgery oncology group Z0030 Trial. Thorac Cardiovasc Surg, 2011, 141(3): 662-670.
10. Wu Y, Huang ZF, Wang SY, et al. A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer. Lung Cancer, 2002, 36(1): 1-6.
11. Sugi K, Nawata K, Fujita N, et al. Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter. World J Surg, 1998, 22(3): 290-294.
12. Wang Y, Wu N, Chen J, et al. Is radical mediastinal lymphadenectomy necessary for elderly patients with clinical N-negative non-small-cell lung cancer? A single center matched-pair study. J Surg Res, 2015, 193(1): 435-441.
13. Wu N, Yan S, Lv C, et al. Does an extended mediastinal lymphadenectomy improve outcome after R0 resection in lung cancer? Chin J Cancer Res, 2014, 26(2): 183-191.
14. Jeon HW, Moon MH, Kim KS, et al. Extent of removal for mediastinal nodal stations for patients with clinical stage I non-small cell lung cancer: effect on outcome. Thorac Cardiovasc Surg, 2014, 62(7): 599-604.
15. Shapiro M, Kadakia S, Lim J, et al. Lobe-specific mediastinal nodal dissection is sufficient during lobectomy by video-assisted thoracic surgery or thoracotomy for early-stage lung cancer. Chest, 2013, 144(5): 1615-1621.
16. Maniwa T, Okumura T, Isaka M, et al. Recurrence of mediastinal node cancer after lobe-specific systematic nodal dissection for non-small-cell lung cancer. Eur J Cardiothorac Surg, 2013, 44(1): 59-64.
17. Jiang W, Chen X, Xi J, et al. Selective mediastinal lymphadenectomy without intraoperative frozen section examinations for clinical stage I non-small-cell lung cancer: retrospective study of 403 cases. World J Surg, 2013, 37(2): 392-397.
18. Takizawa H, Kondo K, Matsuoka H, et al. Effect of mediastinal lymph nodes sampling in patients with clinical stage I non-small cell lung cancer. J Med Invest, 2008, 55(1-2): 37-43.
19. Su X, Wang X, Long H, et al. Mediastinal lymph node dissection affects survival in patients with stage I non-small cell lung cancer. Thorac Cardiovasc Surg, 2008, 56(4): 226-230.
20. Ma K, Chang D, He B, et al. Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer. J Cancer Res Clin Oncol, 2008, 134(12): 1289-1295.
21. Okada M, Sakamoto T, Yuki T, et al. Selective mediastinal lymphadenectomy for clinico-surgical stage I non-small cell lung cancer. Ann Thorac Surg, 2006, 81(3): 1028-1032.
22. Lardinois D, Suter H, Hakki H, et al. Morbidity, survival, and site of recurrence after mediastinal lymph-node dissection versus systematic sampling after complete resection for non-small cell lung cancer. Ann Thorac Surg, 2005, 80(1): 268-274.
23. Doddoli C, Aragon A, Barlesi F, et al. Does the extent of lymph node dissection influence outcome in patients with stage I non-small-cell lung cancer? Eur J Cardiothorac Surg, 2005, 27(4): 680-685.
24. Oda M, Watanabe Y, Shimizu J, et al. Extent of mediastinal node metastasis in clinical stage I non-small-cell lung cancer: the role of systematic nodal dissection. Lung Cancer, 1998, 22(1): 23-30.
25. Bollen EC, van Duin CJ, Theunissen PH, et al. Mediastinal lymph node dissection in resected lung cancer: morbidity and accuracy of staging. Ann Thorac Surg, 1993, 55(4): 961-966.
26. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg, 2006, 81(3): 1013-1019.
27. Wu J, Ohta Y, Minato H, et al. Nodal occult metastasis in patients with peripheral lung adenocarcinoma of 2.0cm or less in diameter. Ann Thorac Surg, 2001, 71(6): 1772-1777.
28. Gu CD, Osaki T, Oyama T, et al. Detection of micrometastatic tumor cells in pN0 lymph nodes of patients with completely resected nonsmall cell lung cancer: impact on recurrence and Survival. Ann Surg, 2002, 235(1): 133-139.
29. Gajra A, Newman N, Gamble GP, et al. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J Clin Oncol, 2003, 21(6): 1029-1034.
30. Okada M, Tsubota N, Yoshimura M, et al. Prognosis of completely resected pN2 non-small cell lung carcinomas: What is the significant node that affects survival? J Thorac Cardiovasc Surg, 1999, 118(2): 270-275.
31. Watanabe S, Asamura H, Suzuki K, et al. The new strategy of selective nodal dissection for lung cancer based on segment-specific patterns of nodal spread. Interact Cardiovasc Thorac Surg, 2005, 4(2): 106-109.
32. Ishiguro F, Matsuo K, Fukui T, et al. Effect of selective lymph node dissection based on patterns of lobe-specific lymph node metastases on patient outcome in patients with resectable non-small cell lung cancer: a large-scale retrospective cohort study applying a propensity score. J Thorac Cardiovasc Surg, 2010, 139(4): 1001-1006.
33. Huang X, Wang J, Chen Q, et al. Mediastinal lymph node dissection versus mediastinal lymph node sampling for early stage non-small cell lung cancer: a systematic review and meta-analysis. PLoS One, 2014, 9(10): 109979.

Chinese Journal of Evidence-Based Medicine

Efficacy and safety of different methods of lymphadenectomy for early stage non-small-cell lung cancer: a meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content