Comparative Effectiveness of a Lymph Node Collection Kit Versus Heightened Awareness on Lung Cancer Surgery Quality and Outcomes.
American College of Surgeons Operative Standard 5.8
Heightened awareness
Lymph node specimen collection kit
Quality of care
Surgical resection
Journal
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
ISSN: 1556-1380
Titre abrégé: J Thorac Oncol
Pays: United States
ID NLM: 101274235
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
30
10
2020
revised:
21
12
2020
accepted:
09
01
2021
pubmed:
16
2
2021
medline:
25
5
2021
entrez:
15
2
2021
Statut:
ppublish
Résumé
The adverse prognostic impact of poor pathologic nodal staging has stimulated efforts to heighten awareness of the problem through guidelines, without guidance on processes to overcome it. We compared heightened awareness (HA) of nodal staging quality versus a lymph node collection kit. We categorized curative-intent lung cancer resections from 2009 to 2020 in a population-based, nonrandomized stepped-wedge implementation study of both interventions, into preintervention baseline, HA, and kit subcohorts. We used differences in proportion and hazard ratios across the subcohorts to estimate the effect of the interventions on poor quality (nonexamination of nodes [pNX] or nonexamination of mediastinal lymph nodes) and attainment of quality recommendations of the National Comprehensive Cancer Network, the Commission on Cancer, and the proposed complete resection definition of the International Association for the Study of Lung Cancer across the three cohorts. Of 3734 resections, 39% were preintervention, 40% kit, and 21% HA cases. Cohort proportions were the following: pNX, 11% (baseline) versus 0% (kit) versus 9% (HA); nonexamination of mediastinal lymph nodes, 27% versus 1% versus 22%; Commission on Cancer benchmark attainment, 14% versus 77% versus 30%; International Association for the Study of Lung Cancer-defined complete resection, 11% versus 58% versus 24%; National Comprehensive Cancer Network attainment, 23% versus 79% versus 35% (p < 0.001 for all, except pNX rate baseline versus HA). Survival rate was significantly higher for both interventions compared with baseline (p < 0.0001). Resections with HA or the kit significantly improved surgical quality and outcomes, but the kit was more effective. We propose to conduct a prospective, institutional cluster-randomized clinical trial comparing both interventions.
Identifiants
pubmed: 33588112
pii: S1556-0864(21)01665-8
doi: 10.1016/j.jtho.2021.01.1618
pmc: PMC8084985
mid: NIHMS1681132
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
774-783Subventions
Organisme : NCI NIH HHS
ID : R01 CA172253
Pays : United States
Informations de copyright
Copyright © 2021 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
Références
N Engl J Med. 2005 Jun 23;352(25):2589-97
pubmed: 15972865
Eur J Cardiothorac Surg. 2012 Apr;41(4):834-8
pubmed: 22290900
Ann Thorac Surg. 2017 May;103(5):1557-1565
pubmed: 28366464
JAMA Oncol. 2018 Jan 1;4(1):80-87
pubmed: 28973110
CA Cancer J Clin. 2020 Jan;70(1):7-30
pubmed: 31912902
Chest. 2005 Sep;128(3):1545-50
pubmed: 16162756
Ann Thorac Surg. 2014 Feb;97(2):385-93
pubmed: 24266949
Ann Thorac Surg. 2013 Oct;96(4):1178-1189
pubmed: 23910633
J Thorac Oncol. 2020 Mar;15(3):344-359
pubmed: 31731014
Lung Cancer. 2005 Jul;49(1):25-33
pubmed: 15949587
J Thorac Oncol. 2016 Oct;11(10):1612-4
pubmed: 27663398
Lung Cancer. 2017 Sep;111:124-130
pubmed: 28838382
Eur J Cardiothorac Surg. 2006 Nov;30(5):787-92
pubmed: 16971134
Lung Cancer. 2007 Mar;55(3):371-7
pubmed: 17123661
J Thorac Oncol. 2020 Mar;15(3):371-382
pubmed: 31783180
J Thorac Oncol. 2009 May;4(5):568-77
pubmed: 19357537
Ann Thorac Surg. 2005 Dec;80(6):2051-6; discussion 2056
pubmed: 16305843
Ann Thorac Surg. 2015 Feb;99(2):421-7
pubmed: 25530090
Ann Thorac Surg. 2016 Nov;102(5):1622-1629
pubmed: 27665479
J Thorac Oncol. 2012 Dec;7(12):1798-1806
pubmed: 23154551
J Thorac Oncol. 2012 Aug;7(8):1276-82
pubmed: 22653076
J Clin Oncol. 2017 Sep 1;35(25):2960-2974
pubmed: 28437162
Ann Thorac Surg. 2019 May;107(5):1487-1493
pubmed: 30594579
Ann Thorac Surg. 2018 Jul;106(1):228-234
pubmed: 29534956
Cancer. 2011 Jan 1;117(1):134-42
pubmed: 20737568
J Thorac Oncol. 2020 Oct;15(10):1670-1681
pubmed: 32574595
Epidemiology. 2000 Sep;11(5):550-60
pubmed: 10955408
J Clin Oncol. 2008 Jul 20;26(21):3552-9
pubmed: 18506026
N Engl J Med. 2004 Jan 22;350(4):351-60
pubmed: 14736927
J Thorac Oncol. 2015 Dec;10(12):1675-84
pubmed: 26709477
Ann Thorac Surg. 2014 Nov;98(5):1755-60; discussion 1760-1
pubmed: 25110337
J Clin Oncol. 2017 Apr 10;35(11):1162-1170
pubmed: 28029318