Site Editor
Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Monday, March 17, 2025
Bilateral mediastinal lymphadenectomy may be linked with both improved disease-free survival and overall survival in patients with solid-dominant, stage I non–small cell lung cancer (NSCLC), according to study results published in JCO Global Oncology. The authors came to their conclusions after comparing postlobectomy survival outcomes of 983 patients who underwent different modes of lymphadenectomy between 2008 and 2015. Lan-Jun Zhang, MD, PhD, of Sun Yat-sen University Cancer Center, Guangzhou, China, and colleagues recommend bilateral mediastinal lymphadenectomy for these patients—especially those with large tumors or more advanced disease—although further randomized studies with longer follow-up are warranted.
The outcomes analyzed were among patients who had bilateral mediastinal lymphadenectomy, systematic nodal dissection, lobe-specific nodal dissection, and selected nodal sampling. The 5-year overall survival rates were 98.2%, 86.9%, 86.4%, and 82.8% (P = .006), respectively, and the 5-year disease-free survival rates were 87.1%, 76.4%, 69.5%, and 70.9% (P = .008).
Propensity score matching revealed that patients who underwent bilateral mediastinal lymphadenectomy had longer overall survival (hazard ratio [HR] = 0.358; P = .052) and disease-free survival (HR = 0.563; P = .081) than patients who underwent systematic nodal dissection. Compared with lobe-specific nodal dissection and selected nodal sampling, bilateral mediastinal lymphadenectomy was associated with significantly improved overall survival (P = .041 and P = .009, respectively) and disease-free survival (P = .016 and P = .032, respectively).
In general, suggested the team, surgeons treating solid-predominant, stage I NSCLC “should pay more attention to the thoroughness of lymph node dissection during surgery. Moreover, [they] should also consider how to minimize surgical trauma and reduce unnecessary clearance of nonmetastatic lymph nodes to preserve the normal tissue structure and function of the body to the maximum extent possible.”
Disclosure: The study authors reported no conflicts of interest.
