60O - The benchmark of examined lymph node count in node positive NSCLC patients: A populational validation with SEER database

Date 07 May 2017
Event ELCC 2017
Session SCLC and early stage NSCLC
Presenter Wenhua Liang
Citation Annals of Oncology (2017) 28 (suppl_2): ii20-ii23. 10.1093/annonc/mdx085
Authors W. Liang1, J. He1, G. Rocco2, T. D’amico3, C.S.H. Ng4, A. Brunelli5, C. Liu6, R.H. Petersen7, J. He1
  • 1Department Of Thoracic Surgery/oncology, The 1st Affiliated Hospital of Guangzhou Medical University, 510120 - Guangzhou/CN
  • 2National Cancer Institute, Naples/IT
  • 3Thoracic Surgery, Duke University Medical Center, Durham/US
  • 4Department Of Surgery, The Chinese University of Hong Kong, Hong Kong/CN
  • 5St. James's University Hospital, Leeds/GB
  • 6Sun Yat-Sen Cancer Center, Taipei/TW
  • 7Rigshospitalet, Copenhagen University Hospital, Copenhagen/DK



Based on SEER database and a Chinese multicenter registry, we previously identified a benchmark for indicating sufficient lymph node (LN) examination among node negative NSCLC patients (Liang et al. J Clin Oncol 2016). Due to variability of LN examination practice, some patients with less than 16 examined LNs might be understaged and therefore have worse survival outcome. This benchmark agrees with the reported mean LN being harvested during complete pulmonary and mediastinal LN exploration, which could serve as a sign for adequate systematic LN sampling and theorectically be applicable to node positive patients as well. We sought to determine its prognostic value among node positive patients using SEER database.


The United States Surveillance, Epidemiology, and End Results (SEER) database on stage I to IIIA completely resected NSCLC (1990-2010) were extracted. Patients were dichotomized according to examined LN count (<16 vs. > =16). Multivariate Cox regression model was used to compare the overall survival (OS) and cancer specific survival (CSS) between groups under adjustment for other prognostic factor.


A total of 12,407 cases met the inclusion criteria with complete data were studied. The median followup was 7.6 years (range 0.1 to 10.0). Patients with <16 examined LNs remained a significant unfavorable factor in terms of both OS (HR 1.34, 95% CI 1.27 to 1.43, P < 0.001) and CSS (HR 1.36, 95% CI 1.27 to 1.45) when compared to those with at least 16 LNs, after adjusting for diagnostic year, sex, age, tumor size, differentiation, pathology and positive LN count. Different subgroups showed consistent trends.


This study confirmed that 16 exmamined LNs could also be considered a benchmark for systematic LN examination among node positive NSCLC patients despite the number of positive LNs. Node positive NSCLC with less than 16 LNs being harvested should be cautiously evaluated for the quality of LN examination and indication for subsequent treatment.

Clinical trial identification

Legal entity responsible for the study

The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China


The 1st Affiliated Hospital of Guangzhou Medical University, Guangzhou, China


T. D’Amico: Consulting or Advisory Role: Scanlan International. C.S.H. Ng: Leadership: Johnson & Johnson; Honoraria: J&J, Covidien, Medtronic; Consulting or Advisory Role: J&J, Covidien, Medtronic; Speakers’ Bureau: J&J, Covidien, Medtronic; Research Funding: J&J, Covidien, Medtronic. A. Brunelli: Honoraria: Bard Medical. C-C. Liu: Honoraria: Johnson & Johnson Consulting or Advisory Role: Johnson & Johnson Travel, Accommodation, Expenses: Johnson & Johnson (I). R.H. Petersen: Honoraria: Medtronic, Ethicon, Medela. J. He: Consulting or Advisory Role: Johnson & Johnson. All other authors have declared no conflicts of interest.