Objectives

We aimed to compare the differences in prognosis and perioperative complications between patients with and without mediastinal lymph node dissection (MLND) among elderly patients with clinical stage I non-small cell lung cancer (NSCLC).

Methods

We analysed 439 patients ≥ 75 years of age with NSCLC classified as clinical stage I who underwent complete resection with lobectomy. We divided the patients into two groups. Those with MLND were included in the MLND group (n = 365), and those without MLND or adequate systematic mediastinal lymph node sampling were included in the non-MLND group (n = 74). To reduce selection bias, a propensity score matching method (3:1) was implemented. We compared survival and the incidence of perioperative complications.

Results

After matching, we compared 171 patients in the MLND group to 57 patients in the non-MLND group. There were no significant differences in clinicopathological characteristics between the groups. The non-MLND group did not show a significantly better prognosis than the MLND group in overall survival and cancer-specific survival (p = 0.246 and 0.150, respectively). The cumulative incidence of recurrence was similar in the two groups. MLND did not affect chest drain duration or hospitalization. The numbers of patients with perioperative complications ≥ grade 2 or ≥ grade 3 did not differ between the groups (p = 0.312 and > 0.999, respectively).

Conclusions

Anatomical pulmonary resection without MLND might be a treatment option for elderly patients with clinical stage I NSCLC. Further investigation is needed to clarify the value of MLND, especially for vulnerable elderly individuals.

中文翻译：

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老年临床Ⅰ期非小细胞肺癌纵隔淋巴结清扫术

目标

我们旨在比较临床 I 期非小细胞肺癌 (NSCLC) 老年患者中纵隔淋巴结清扫术 (MLND) 与非纵隔淋巴结清扫术 (MLND) 患者预后和围手术期并发症的差异。

方法

我们分析了 439 名≥ 75 岁的临床 I 期 NSCLC 患者，这些患者接受了肺叶切除术的完全切除。我们将患者分为两组。MLND 患者包括在 MLND 组中（n  = 365），而那些没有 MLND 或没有充分系统纵隔淋巴结取样的人包括在非 MLND 组中（n  = 74）。为了减少选择偏差，实施了倾向得分匹配方法 (3:1)。我们比较了生存率和围手术期并发症的发生率。

结果

匹配后，我们将 MLND 组的 171 名患者与非 MLND 组的 57 名患者进行了比较。各组间临床病理特征无显着差异。非 MLND 组的总生存期和癌症特异性生存期并未显示出明显优于 MLND 组的预后（分别为p  = 0.246 和 0.150）。两组的累积复发率相似。MLND 不影响胸腔引流持续时间或住院。围手术期并发症≥ 2 级或≥ 3 级的患者数量在各组之间没有差异（分别为p  = 0.312 和 > 0.999）。

结论

没有 MLND 的解剖肺切除术可能是临床 I 期 NSCLC 老年患者的治疗选择。需要进一步调查以阐明 MLND 的价值，尤其是对于弱势老年人。