Multicenter cohort study of lymph node dissection guideline adherence and survival in patients with T1N0M0 lung adenocarcinoma

Lymph node dissection for early-stage lung adenocarcinoma is controversial. A multicenter cohort study using data from the National Cancer Center LungReal database investigated the association of guideline-adherent lymph node dissection and overall survival in 27,191 patients with clinical T1N0M0 lung adenocarcinoma from 2014 througt 2021, with last follow-up in December 2022. In this cohort study, lymph node dissection adherent with the 3+1 standard (HR 0.81; 95% CI 0.69-0,95; absolute risk difference at 3 years 1.2%) or the 6-station standard (HR 0.61; 95% CI 0.45-0.83; absolute risk difference at 3 years 1.0%) was associated with survival benefit among patients with adenocarcinoma of high-grade or no lepidic pattern, but not with lepidic without high-grade pattern (3+1 standard: HR 0.81; 95% CI 0.57-1.15 and 6 standard: HR 0.54; 95% CI 0.26-1.13). The authors conclude that these findings suggest that the survival impact of guideline-adherent lymp node dissection differed among patients with adenocarcinomas of different histologic pattern types.