The following is the summary of “946P – Non-examination of lymph nodes (LN) in early-stage non-small cell lung cancer (eNSCLC) is associated with wedge resections and underutilization of adjuvant (adv) chemotherapy” published in the September 2022 issue of Oncology by Lee, et al.

Patients with esophageal, nasopharyngeal, and/or gastric adenocarcinomas (pts) who undergo LN evaluation are more likely to meet the IASLC full resection criteria and have better perioperative chemotherapy outcomes. LN non-examination has been linked to overall survival rates that are on par with those of patients with LN metastases, likely as a result of insufficient adv therapy (tx), according to previous studies. Patients with e-NSCLC who were enrolled in the US Medicare program were analyzed to see how often they had a lymph node (LN) exam and advanced treatment. Patients with AJCC 7th edition stage IA-IIIB NSCLC were identified in this retrospective observational study using SEER data connected with Medicare claims. 

Patients were ≥ 65 when they were diagnosed between January 2010 and December 2017, underwent surgery within a month before or after diagnosis, and were consistently enrolled in Medicare Parts A and B for at least six months prior to diagnosis. Adv tx results necessitated additional criteria of continuing participation of Medicare Parts A, B, and D ≥6 months post-surgery or up to date of death. Patients were divided into three categories based on the results of their lymph node (LN) biopsies: pNX, pN0, and pN1/2. Within 6 months or till death, advanced tx was detected after surgery. A descriptive statistical method was utilized to compile a final report.

Among the total of 14,684 pts included, there were 1,596 pNX (11%), 9,943 pN0 (68%), and 3,145 pN1/2 (21%). From 2010-2017, the share of pNX points went from 14% to 8%. On average, 11 (9) LNs were analyzed (median, 9; IQR, 5-15). Patients with pNX (21%), pN0 (13%), and pN1/2 (63%), respectively, were found to benefit from advchemotherapy. In 47% of pts (pNX), 18% (pN0), and 11% (pN1/2), wedge resections were carried out. The number of lymph nodes removed during resection has increased, allowing for better LN evaluation in Medicare patients with eNSCLC. However, many resections still do not include LN examination, and pNX was linked with lower adv chemotherapeutic utilization rates than pN1/2, lending further credence to the idea that pNX may negatively impact adv tx decisions.