NSCLC surgery: vein-first ligation cuts CTCs, improves survival

  • JAMA Surg

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • A vein-first (V-first) technique during lobectomy for NSCLC, in which the pulmonary vein is ligated first, yielded better survival than an artery-first (A-first) technique, in which the pulmonary artery was ligated first.

Why this matters

  • The V-first technique reduced the dissemination of folate receptor-positive (FR+) circulating tumor cells (CTCs), which could improve outcomes.
  • "The [study] adds to our understanding of how metastases develop in patients with early-stage lung cancer," commented Mark K. Ferguson, MD, from the University of Chicago, in an editorial.

Study design

  • 86 patients with NSCLC randomly assigned to lobectomy with a V-first (n=43) or A-first (n=43) technique.
  • 210 propensity-matched NSCLC patient pairs from the Western China Lung Cancer database.
  • Median follow-up, 30 months.
  • Funding: National Natural Science Foundation of China; others.

Key results

  • Overall, V-first was associated with a smaller postsurgery incremental change in FR+ CTCs than A-first (31.6% vs 65.0%; P=.003).
  • In propensity-matched analysis, V-first offered significantly better 5-year OS (73.6% vs 57.6%; P=.002), DFS (64.6% vs 48.4%; P=.001), and lung cancer-specific survival (LCSS; 76.4% vs 59.9%; P=.002).
  • Improved OS and DFS were limited to patients with stage I and II disease.
  • In multivariate analysis, A-first lobectomy was associated with worse 5-year OS (HR, 1.65; P=.03), DFS (HR, 1.43; P=.05), and LCSS (HR, 1.65; P=.03).

Limitations

  • Small size, retrospective database.

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