A structural dose-response relationship between lymph node yield and survival after anatomical segmentectomy for early-stage NSCLC: a SEER-based retrospective cohort study
In brief
Examining over 10 nodes tracked with 84% five-year survival after segmentectomy
In a retrospective study of 2,217 patients with small, node-negative lung cancer, five-year overall survival rose from 52.5% when no nodes were examined to 83.9% when more than 10 were examined. The association persisted after adjustment, but the study cannot show that examining more nodes caused better survival; node yield may instead mark the quality of care or other differences.
- Journal
- Translational lung cancer research (Q1)
- Published
- 17 August 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Ye Tian, Edoardo Zanfrini, Etienne Abdelnour-Berchtold, Jean Yannis Perentes, Thorsten Krueger, Michel Gonzalez
- PMID
- 42870936
- DOI
- 10.21037/tlcr-2026-0850
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 19 October 2026): Higher lymph node yield improves survival after segmentectomy
Abstract
BACKGROUND: Adequate lymph node evaluation is central to oncologic segmentectomy for early-stage non-small cell lung cancer (NSCLC), yet the quantitative relationship between lymph node yield and survival remains unclear. This study aimed to evaluate the association between regional lymph node yield and overall survival after segmentectomy for early-stage NSCLC. METHODS: Using Surveillance, Epidemiology, and End Results (SEER) (2000-2022), we identified patients with NSCLC undergoing anatomical segmentectomy and clinical N0M0 disease with tumors ≤30 mm. Regional lymph node yield ("regional nodes examined") was analyzed as 0, 1-5, 6-10, and >10 nodes, and continuously using restricted cubic splines. Overall survival (OS) was evaluated with Kaplan-Meier and multivariable Cox regression. Lung cancer-specific death was assessed using Fine-Gray competing-risk models. RESULTS: A total of 2,217 patients met inclusion criteria (median follow-up 58 months), with 783 deaths during follow-up. OS differed significantly across lymph node yield groups (log-rank P<0.001). Five-year OS increased stepwise with higher yield, from 52.5% for 0 nodes to 65.9% for 1-5 nodes, 77.4% for 6-10 nodes, and 83.9% for >10 nodes. In multivariable Cox models, higher yields were independently associated with lower all-cause mortality: 1-5 nodes, hazard ratio (HR) =0.79 [95% confidence interval (CI): 0.67-0.94]; 6-10 nodes, HR =0.55 (95% CI: 0.44-0.70), and >10 nodes, HR =0.40 (95% CI: 0.30-0.52) (all P≤0.006; P for trend <0.001). Restricted cubic spline analysis supported a continuous association between yield and mortality risk without strong evidence of non-linearity (P overall <0.001; P non-linearity =0.27). The association was consistent across age (<70 vs. ≥70 years) and tumor size strata (T1a-c), without significant interaction. CONCLUSIONS: In SEER patients undergoing anatomical segmentectomy for clinical N0M0 NSCLC ≤30 mm, higher regional lymph node yield demonstrated a dose-response association with higher OS and lower lung cancer-specific mortality. These findings support lymph node yield as a pragmatic marker of nodal evaluation during segmentectomy.
Abstract as published, via PubMed.
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