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According to a recent article published in the Journal of Clinical Oncology, the evaluation of a larger number of lymph nodes during initial surgery is associated with improved survival in patients with early-stage non-small cell lung cancer.

Lung cancer is the leading cause of cancer deaths in the United States. Non-small cell lung cancer (NSCLC) refers to the type of cells in which the cancer originated. When caught early, before the spread to distant sites in the body, the surgical removal of NSCLC with or without additional therapy results in a high cure rate. Standard treatment options depend upon the specific stage, or extent of spread, of cancer; therefore, it is imperative that physicians accurately determine the stage of NSCLC at the time of diagnosis so optimal therapy can be initiated.

During surgery for early-stage NSCLC, physicians often remove nearby lymph nodes and send them to the laboratory to determine if they contain cancer cells. The number of lymph nodes removed is often based on physician preference and sampling and reporting of the evaluation of lymph nodes is not uniform among all laboratories and pathologists. Recently, researchers from New York analyzed data from 442 patients with NSCLC to determine if the number of lymph nodes sampled during initial surgery to remove cancer affects long-term outcomes.

Patients in this study had been diagnosed with stage I NSCLC and were divided into four different groups depending on the number of lymph nodes removed and examined: 0 to 3, 4 to 6, 7 to 9, and more than 9. At 5 years, overall survival rates for these four groups of patients were 47%, 73%, 76% and 79%, respectively. Cancer-free survival rates at 5 years for the groups of patients were 43%, 67%, 76% and 75%, respectively.

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The researchers analyzing this data suggest that 6 or more lymph nodes should be surgically removed and evaluated in all patients with stage I NSCLC undergoing surgery to remove cancer. The results from this data suggest that patients with a larger number of sampled lymph nodes may be more accurately staged and receive more appropriate therapy, ultimately leading to improved overall and cancer-free survival. Patients diagnosed with early-stage NSCLC may wish to speak with their physician about standard surgical procedures involving the number of lymph nodes removed and evaluated at the institution at which the surgery will be performed and/or the surgeon performing the operation.

Reference: Gajra A, Newman N, Gamble G, et al. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer.

Journal of Clinical Oncology. 2003;21:1029-1034.

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