146. The extent of lymph node dissection is not associated with disease-free survival following lobar or sublobar resection: results from CALGB 140503 (Alliance)

Objective
The extent of lymphadenectomy in patients (pts) with c-stage I non-small cell lung cancer (NSCLC) is controversial. CALGB 140503 (Alliance; NCT00499330) randomized pts with peripheral c-stage 1A NSCLC  2 cm to lobar (LR) or sublobar resection (SLR). Pts were eligible for randomization after frozen section examination of ≥2 mediastinal and 1 major hilar node (simple sampling) confirmed the absence of nodal metastases. After randomization, additional node dissection was performed at the investigator's discretion and included simple sampling (S), systematic sampling (SS), or complete lymph node dissection (CLND). We report the impact of the extent of LND on recurrence- and disease-free survival (RFS and DFS) in this trial.
Methods
Between 6/2007 and 3/2017, 697 pts were randomized to LR (357) or SLR (340).182 had CLND, 349 had SS and 158 had S. DFS was defined as time to lung cancer (LC) recurrence and/or all-cause mortality. RFS was defined as the time to LC recurrence or death from LC. Survival endpoints were estimated by the Kaplan–Meier method. Hazard ratios and their confidence intervals were estimated using stratified Cox proportional-hazards models.
Results
Baseline characteristics were similar between groups (Table) except that pts who had S were more likely to have SLR, pts who had SS had more squamous cell cancers and pts who had CLND had more nodal stations sampled. 5-year (yr) DFS was 62.3% (95%CI: 55.2 − 70.4%) after CLND, 65.7% (95%CI: 60.7 − 71.2%) after SS, and 61.2% (95%CI: 53.7 − 69.7%) after S (p=0.306). DFS was not statistically significantly different between LR and SLR based on the extent of node dissection. 5-yr DFS among pts who had CLND was 65% (95%CI: 56.4 − 76.6%) after LR and 58.5% (95%CI: 48.2 − 71.1%) after SLR (p=0.530).5-yr DFS in pts who had S/SS was 63.4% (95%CI: 57.5 − 69.8%) after LR and 65.0% (95%CI: 59.1 − 71.5%) after SLR) (p=0.702). 5-yr RFS for pts who had CLND was 72.5% (95% CI:63.5 − 82.9%) after LR and 68.9% (95%CI: 59.0 − 80.5%) after SLR (p=0.526). 5-yr RFS in pts who had S/SS was 70.6% (95%CI: 64.9 − 76.9%) after LR and 70.4% (95%CI: 64.6 − 76.7%) after SLR) (p=0.764).
Conclusions
In pts with peripheral c-stage IA NSCLC  2 cm in size who had no nodal metastases to at least 2 mediastinal and 1 major hilar lymph nodes, there was no difference in DFS or RFS based on the extent of lymph node dissection irrespective of the magnitude of parenchymal resection.
U10CA180821, U10CA180882; https://ackn

Nasser Altorki (1), Bryce Damman (2), Xiaofei Wang (3), Moishe Liberman (4), Dennis Wigle (5), Ahmad Ashrafi (6), Massimo Conti (7), Kazuhiro Yasufuku (8), Matthew Schuchert (9), Thomas Stinchcombe (10), (1) New York Presbyterian, New York, NY, (2) Mayo Clinic, Rochester, MN, (3) N/A, United States, (4) Centre Hospitalier de l'Université de Montréal, Montreal, QC, (5) Mayo Clinic - Rochester, Rochester, MN, (6) Surrey Memorial Hospital Thoracic Group Fraser Valley Health Authority, Surrey, NA, (7) Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, NA, (8) Toronto General Hospital, Toronto, ON, (9) University of Pittsburgh Medical Center, Pittsburgh, PA, (10) Duke University Medical Center, Sainte-Anne-Des-Lacs, QC

Gaetano Rocco

Commentator

Dr. Rocco received his medical degree from the University of Milan in Italy (1985). After general (1990) and thoracic (1995) surgery residencies at the University of Milan, Dr. Rocco completed a visiting residency and clinical fellowship in advanced general thoracic surgery at the Mayo Clinic(1996-1997).Dr. Rocco has served on the surgical faculty of E. Morelli Regional Hospital, in Sondalo, Italy (1988-1999), and as a Consultant and Senior Clinical Lecturer at the Sheffield Teaching Hospitals of the University of Sheffield, England (2000-2004).From 2004 to 2018, Dr. Rocco served as the Chief of Thoracic Surgery and Chair of the Department of Thoracic Surgery and Oncology at the National Cancer Institute “G. Pascale” Foundation in Italy. In 2018, Dr. Rocco joined the faculty at Memorial Sloan Kettering as an Attending and Member in the Thoracic Service, Department of Surgery, and as a Full Professor of Cardiothoracic Surgery at Weill Cornell Medical College in New York.Dr. Rocco has been the Editor of the European Society of Thoracic Surgeons (ESTS) and Associate Editor of the European Journal of Cardio-Thoracic Surgery. He is currently an Associate Editor of the Journal of Thoracic and Cardiovascular Surgery and co-Editor of Shields’ General Thoracic Surgery textbook. Dr. Rocco is a past President of the ESTS and served as Director of Education and Treasurer of the same organization. He co-founded the ESTS School of Thoracic Surgery in 2007.Dr. Rocco’s research has been funded by the Italian Ministry of Health and the Italian Association for Cancer Research, among other places. He has authored or co-authored over 420 peer-reviewed articles, wrote several textbook chapters,  played a lead role in 25-plus clinical trials, and given more than 300 invited lectures around the world. 

Nasser Altorki

Abstract Presenter

Chief Division of Thoracic Surgery

Leader Experimental Therapeutics Program at Meyer Cancer Center  of Weill Cornell Mediicine

Specialties: Congenital, Thoracic