Adherence to the mediastinal staging guideline and unforeseen N2 disease in patients with resectable non-small cell lung cancer: Nationwide results from the Dutch Lung Cancer Audit - Surgery.
Adenocarcinoma of Lung
/ pathology
Aged
Carcinoma, Non-Small-Cell Lung
/ pathology
Carcinoma, Squamous Cell
/ pathology
Endosonography
Female
Follow-Up Studies
Guideline Adherence
/ statistics & numerical data
Humans
Lung Neoplasms
/ pathology
Male
Mediastinal Neoplasms
/ pathology
Mediastinoscopy
Neoplasm Staging
Positron Emission Tomography Computed Tomography
Practice Guidelines as Topic
/ standards
Pulmonary Surgical Procedures
Endosonography
Mediastinal lymph node staging
Mediastinoscopy
Non-small cell lung cancer
Thoracic surgery
Unforeseen N2 disease
Journal
Lung cancer (Amsterdam, Netherlands)
ISSN: 1872-8332
Titre abrégé: Lung Cancer
Pays: Ireland
ID NLM: 8800805
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
22
11
2019
revised:
08
02
2020
accepted:
13
02
2020
pubmed:
24
2
2020
medline:
13
4
2021
entrez:
24
2
2020
Statut:
ppublish
Résumé
Invasive mediastinal staging is advised by guidelines in patients with resectable non-small cell lung cancer (NSCLC) and suspicious lymph nodes (cN1-3) or for central, FDG-non-avid or peripheral tumours >3 cm. Our objective was to assess current guideline adherence and consequent unforeseen N2 disease (uN2) in NSCLC patients having various indications for mediastinal staging. We analysed the Dutch Lung Cancer Audit - Surgery data of all patients who underwent a primary lung resection with lymph node dissection for NSCLC in 2017-2018. Based on the 2015 ESTS-ERS-ESGE guideline we assessed the use of initial endosonography and confirmatory mediastinoscopy as well as uN2 rates. A total of 2238 patients were analysed. 43 % (95 %-CI: 41-45) underwent initial endosonography followed by a confirmatory mediastinoscopy in 44 % (95 %-CI:40-47) of them, resulting in a 19 % (95 %-CI: 17-20) rate of properly staged patient according to the guidelines. uN2 was demonstrated in 12.5 % (95 %-CI: 9.7-16.0) of correctly staged patients compared to 10.9 % (95 %-CI: 9.6-12.4) who were not (p = .36). The highest uN2 rate was found in cN1-3 patients who were not staged (23.0 %, 95 %-CI: 16.4-31.2) compared to 13.0 % (95 %-CI: 9.7-17.1) who were (p = .01). Guideline adherence in Dutch NSCLC patients with an indication for invasive mediastinal staging is poor. The highest uN2 rate was found in unstaged cN1-3 patients, suggesting that this subgroup may benefit from an appropriate staging conform guidelines.
Identifiants
pubmed: 32088606
pii: S0169-5002(20)30305-6
doi: 10.1016/j.lungcan.2020.02.008
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
51-58Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of Competing Interest Dr. Bousema, Dr. Heineman, Prof. Dr. Dijkgraaf and Dr. Van Den Broek have nothing to disclose. Prof. Dr. Annema reports non-financial support from Hitachi Medical systems, non-financial support from Pentax, grants from Cook medical, outside the submitted work.