Lymph node collection kit improves outcomes of lung cancer resection

Raymond U.

Osarogiagbon

CHICAGO — The use of a lymph node specimen collection kit during non-small cell lung cancer resection significantly improved staging quality and OS, according to data presented at ASCO.

The American Lung Association estimates that 541,000 people in the United States have been diagnosed with lung cancer, and 234,030 new cases are projected to occur this year. Surgical resection remains the optimal curative modality for non-small cell lung cancer (NSCLC), according to Raymond U. Osarogiagbon, MBBS, FACP, research professor at the University of Memphis School of Public Health and director of the multidisciplinary thoracic oncology program at Baptist Cancer Center in Memphis, Tennessee, and colleagues. About 85,000 patients with NSCLC undergo the procedure in the U.S. each year.

“Out of the minority of NSCLC patients who undergo curative intent resection comes the vast majority of 5-year survivors of lung cancer,” Osarogiagbon said during a presentation at ASCO. “Unfortunately, only about 50% of these patients with ostensibly curable NSCLC actually go on to manifest the destiny of survivorship at 5 years.”

Existing data highlight gaps in the quality of pathological nodal staging, which is “the most prognostic factor” of survival, according to Osarogiagbon. To address this, Osarogiagbon and colleagues developed a pre-labeled lymph node specimen collection kit that is designed to remind surgeons of adequate dissection practices and pathology teams of proper examination methods.

After the kit was shown to be beneficial during pilot studies, the researchers assessed its efficacy during a real-world prospective study conducted at 12 institutions in Mississippi, Arkansas and Tennessee. Each institution implemented the kit after a 3- to 9-month observation period. Patients who underwent NSCLC resection were followed for approximately 20 months.

From 2014 to 2017, a total of 1,171 procedures were performed by 32 surgeons. The kit was used in 650 of the procedures (56%).

Osarogiagbon said the kits significantly improved the oncologic quality of surgical resection. In addition, 3-year OS rates were higher among patients who underwent NSCLC resection with the kit vs. those who underwent a standard NSCLC resection (80% vs. 73%; adjusted HR = 0.57; 95% CI, 0.42-0.77).

The duration of surgical procedures that used the kit was shorter than procedures that did not use kit (124 minutes vs. 144 minutes; P < .0001), which Osarogiagbon said was “somewhat surprising” given the more thorough lymph node retrieval methods with the kit. The incidence of perioperative morbidities and complications were similar with or without the kit.

During a post-implementation period, Osarogiagbon said staging quality reverted back to baseline levels.

“So, in conclusion, the lymph node specimen collection kit improves the quality of pathological nodal staging [and] improved OS without adding to morbidity or postoperative mortality,” he said. “A prospective institutional cluster randomized trial with strategies to improve lymph node examination in NSCL tumors, SILENT — which would recruit institutions of much broader geographic and structural heterogeneity, ranging from large community health care systems to NCI-designated cancer centers — is in its planning process.” – by Stephanie Viguers

Reference:

Osarogiagbon RU, et al. Abstract 8502. Presented at: ASCO Annual Meeting; June 1-5, 2018; Chicago.

Disclosures: Osarogiagbon reports receiving stock and other ownership interests from the Foundation Medicine, Lilly and Pfizer; honoraria from Genentech/Roche; consulting or advisory fees from Lilly, Pfizer and Genentech/Roche; speakers' bureau fees from Genentech/Roche; and has a pending patent on the Lung Cancer Specimen Kit.