Long-term outcomes after near-infrared sentinel lymph node mapping in non-small cell lung cancer

• Type of Material: Article
• Authors: Christopher S. Digesu, Brigham and Women's Hospital; Krista J. Hachey, Boston Medical Center; Denis M. Gilmore, Vanderbilt University; Onkar Khullar, Emory University; Hisashi Tsukada, Brigham and Women's Hospital; Brian Whang, Brigham and Women's Hospital; Lucian R. Chirieac, Brigham and Women's Hospital; Robert F. Padera, Brigham and Women's Hospital; Michael T. Jaklitsch, Brigham and Women's Hospital; Yolonda L. Colson, Brigham and Women's Hospital
• Language: English
• Date: 2018-03-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2017 The American Association for Thoracic Surgery
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jtcvs.2017.09.150
• Title of Journal or Parent Work: Journal of Thoracic and Cardiovascular Surgery
• ISSN: 0022-5223
• Volume: 155
• Issue: 3
• Start Page: 1280
• End Page: 1291
• Grant/Funding Information: The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH Award UL1 TR001102) and financial contributions from Harvard University and its affiliated academic healthcare centers.; This work was supported by NIH R01CA131044, the Karl Storz Society of University Surgeons Resident Scholar Award (to K.H.), and the Brigham and Women's Hospital Advanced Training in Surgical Oncology T32 Fellowship (5T32CA009535) for K.H., CD., D.G., and O.K.; This work was conducted with support from Harvard Catalyst
• Keywords: ADENOCARCINOMAS; THORACIC-SURGERY; OPEN LOBECTOMY; Life Sciences & Biomedicine; Science & Technology; Respiratory System; RECURRENCE; Cardiac & Cardiovascular Systems; lung cancer; TRIAL; TUMOR-CELLS; EXPRESSION; METASTATIC SITES; Cardiovascular System & Cardiology; outcomes; sentinel lymph node; Surgery; MODEL; near-infrared; SURVIVAL
• Research Categories: Health Sciences, Oncology; Health Sciences, Pathology; Health Sciences, Medicine and Surgery

Abstract

Objective: To report the first analysis of long-term outcomes using near-infrared (NIR) image-guided sentinel lymph node (SLN) mapping in non–small cell lung cancer (NSCLC). Methods: Retrospective analysis of patients with NSCLC enrolled in 2 prospective phase 1 NIR-guided SLN mapping trials, including an indocyanine green (ICG) dose-escalation trial, was performed. All patients underwent NIR imaging for SLN identification followed by multistation mediastinal lymph node sampling (MLNS) and pathologic assessment. Disease-free (DFS) and overall survival (OS) were compared between patients with NIR+ SLN (SLN group) and those without (non-SLN group). Results: SLN detection, recurrence, DFS, and OS were assessed in 42 patients with NSCLC who underwent intraoperative peritumoral ICG injection, NIR imaging, and MLNS. NIR+ SLNs were identified in 23 patients (SLN group), whereas SLNs were not identified in 19 patients enrolled before ICG dose and camera optimization (non-SLN group). Median follow-up was 44.5 months. Pathology from NIR+ SLNs was concordant with overall nodal status in all 23 patients. Sixteen patients with SLN were deemed pN0 and no recurrences were, whereas 4 of 15 pN0 non-SLN patients developed nodal or distant recurrent disease. Comparing SLN versus non-SLN pN0 patients, the probability of 5-year OS is 100% versus 70.0% (P =.062) and 5-year DFS is statistically significantly improved at 100% versus 66.1% (P =.036), respectively. Among the 11 pN+ patients, 7 were in the SLN group, with >40% showing metastases in the SLN alone. Conclusions: Patients with pN0 SLNs showed favorable disease-free and overall survival. This preliminary review of NIR SLN mapping in NSCLC suggests that pN0 SLNs may better represent true N0 status. A larger clinical trial is planned to validate these findings.