1176O - Impact of harvested lymph nodes count on staging and survival at radical resection for non-small cell lung cancer: A minimum of 14 lymph nodes shou...

Date 28 September 2014
Event ESMO 2014
Session NSCLC early stage
Topics Non-Small Cell Lung Cancer
Staging Procedures (clinical staging)
Surgical Oncology
Basic Principles in the Management and Treatment (of cancer)
Radiation Oncology
Presenter Wenhua Liang
Citation Annals of Oncology (2014) 25 (suppl_4): iv409-iv416. 10.1093/annonc/mdu347
Authors W. Liang1, H. Pan2, Q. Wang3, L. Liu4, G. Jiang5, D. Liu6, Z. Wang7, Z. Zhu8, J. He9
  • 1Department Of Thoracic Oncology, the First Affiliated Hospital of Guangzhou Medical University, 510120 - Guangzhou/CN
  • 2Thoracic Oncology, The first affiliated hospital of Guangzhou Medical School, Guangzhou/CN
  • 3Department Of Thoracic Surgery, Shanghai Zhongshan Hospital of Fudan University, Shanghai/CN
  • 4Department Of Thoracic Surgery, West China Hospital, Sichuan University, Sichuan/CN
  • 5Department Of Thoracic Surgery, Shanghai Pulmonary Hospital of Tongji University, Shanghai/CN
  • 6Department Of Thoracic Surgery, China and Japan Friendship Hospital, Beijing/CN
  • 7Department Of Thoracic Surgery, Shenzhen People’s Hospital, Shenzhen/CN
  • 8Department Of Thoracic Surgery, Cancer Center of Sun Yat-Sen University, Guangzhou/CN
  • 9Department Of Thoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, 510120 - Guangzhou/CN



Lymph node (LN) status is the most important prognostic factor in patients with resectable non-small cell lung cancer (NSCLC) who underwent radical surgery. However, the impact of total number of LNs being harvested during surgery on staging and overall survival (OS) remains controversial. In addition, the minimum count of LN that should be examined to accurately determine stage or identify high risk patients has not been recommended.


A cohort of 5729 NSCLC patients from a multi-institutional registry in China (2001-2008) was collected to examine the relationship between harvested LN count and OS or staging. Subgroup analyses for patients with disease of different stages or histology types were proposed. An independent cohort of 546 patients from our center (2009-2010) on which the systematic LN dissection (SLND) was guaranteed was also examined to confirm the results.


Total number of LN examined was positively correlated with 5-year OS (R2 = 0.538, P = 0.016). Cut-point analysis identified the greatest survival difference at 14 LNs examined (χ2 = 27.2) and survival analysis revealed significant longer median overall survival of patients being harvested for at least 14 LNs (100 vs. 73 months; P < 0.001). In multivariate analysis, the association of harvesting 14 or more LNs and survival benefit was confirmed (HRajusted = 0.73, 95% CI 0.66-0.81; P < 0.001) after adjusting fully for histology, T stage, N stage, etc. The linear regression results showed a proportional increase in TNM stage as the number of LNs examined increased (P < 0.001). The SLND-guaranteed cohort from our center confirmed the positive relationship between 5-year OS and LN count, as well as the favorable OS of patients in whom at least 14 LNs were harvested (P = 0.05).


The current results suggested that more LN harvested favors OS in patients underwent radical resection for NSCLC. We recommended a minimum of 14 LNs should be harvested to accurately stage the disease and to improve patient survival.


All authors have declared no conflicts of interest.