Correspondence - A commentary on ‘Impact of lymphadenectomy extent on immunotherapy efficacy in postresectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study’

Sep 21, 2026

Upload by Aria

Letter-style commentary evaluating a retrospective multi-institutional study on non-small cell lung cancer recurrence treated with anti-PD-1 immunotherapy. The commentary highlights reported links between lower immunotherapy efficacy and higher dissected lymph node counts, notes possible influence of CD8+ Tcm ratios in lymph nodes, and discusses clinical relevance of lymph node dissection and nodal staging. It also addresses limitations, including retrospective design, China-only cohort selection bias, and small multi-center sample size, and calls for larger prospective research and trials.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Dear Editor

Immunotherapy efficacy and dissected lymph node count

Clinical context of lymph node dissection

Commentary strengths and limitations

Ethical approval, consent, and funding

Author contributions, conflicts of interest, and data availability

References

’Correspondence A commentary on ‘Impact of lymphadenectomy extent on immunotherapy efﬁcacy in postresectional recurred non-small cell lung cancer: a multi-institutional retrospective cohort study’ Chengcheng Zhang, PhD, Jingru Qin, MD, Xiaoxue Zhao, MD, Lu Yang, MD, Zhongqi Wang, PhD* Dear Editor, It was with great interest that we read the article published in the International Journal of Surgery. Deng et al.[1] conducted a retrospective cohort study on non-small cell lung cancer(NSCLC)patients with anti-PD-1 immunotherapy for recurrence. The ﬁndings showed that lower immunotherapy efﬁcacy in recurrent NSCLC was correlated with an elevated dissected lymph node (DLN) count (cutoff: 16), a correlation that was particularly strong in the immunotherapy alone subgroup. The ratios of CD8+Tcm in lymph nodes may also affect the effectiveness of immunotherapy. With around 85% of people having NSCLC, lung cancer is the primary cause of cancer-related death globally[2] . Radiation surgical resection is still the gold standard of therapy for NSCLC that is resectable at an early stage[3]. The 5-year survival rate following resection, however, is only 50–60% . In addition to being utilized therapeutically to remove metastatic disease for loco-regional control, lymph node dissection (LND) is also used to establish the best nodal staging for adjuvant therapy or prognostic prediction[4]. However, insufﬁcient LND could be very detrimental since it could result in stage migration or residual metastatic disease, which is a sign of how well the NSCLC surgery went. One of the main purposes of LND is to conﬁrm the number of LNs studied, and the quantity is related to the prognosis of different types of cancer. Nevertheless, there hasn’t been enough discussion of how the quantity of LNs investigated in NSCLC affects prognosis. This multi-institutional retrospective study aims to demonstrate the immunological implications of LN dissection at the quantitative Department of Medical Oncology, Longhua Hospital afﬁliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China Chengcheng Zhang and Jingru Qin contributed equally to the article. Sponsorships or competing interests that maybe relevant to content are disclosed atthe end of this article. *Corresponding author. Address: Department of Medical Oncology, Longhua Hospital afﬁliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, People’s Republic of China. Tel.: +862 164 385 700; fax: +216 438 5700. [E-mail: aledx@sina.com](E-mail: aledx@sina.com) (Z. Wang). Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others to remix, tweak, and build upon the work, even for commercial purposes, as long as the author is credited and the new creations are licensed under the identical terms. International Journal of Surgery (2024) 110:4437–4438 Received 27 February 2024; Accepted 3 March 2024 Published online 12 March 2024 [http://dx.doi.org/10.1097/JS9.0000000000001347](http://dx.doi.org/10.1097/JS9.0000000000001347) level for NSCLC patients with validation from multicenters and propose a novel concept of ʻimmunotherapy-drivenʼ LN dissection strategy. And it well expounded the advantages and limitations. This innovative strategy offers insightful direction and motivation for the ongoing advancement of this ﬁeld of study. But there remained some things to be concerned about. First, this was a retrospective study; therefore, unobserved potential confounders could not be resolved. Second, the study only included patients from China, which may cause selection bias. Finally, this study was conducted in four centers with a small sample size. Therefore, further study required large sample sizes. More detailed and multicenter research is required to conﬁrm this result. Furthermore, deepe

FAQs

What relationship does the commentary describe between lymph node dissection extent and immunotherapy efficacy?

It states that lower immunotherapy efficacy in recurrent NSCLC correlates with an elevated dissected lymph node (DLN) count (cutoff: 16), with the strongest association in the immunotherapy-alone subgroup.

Why do the authors emphasize lymph node dissection in NSCLC treatment and prognosis?

LND is described as both therapeutic for loco-regional control and important for nodal staging and prognostic prediction; inadequate LND may cause stage migration or leave residual metastatic disease.

What main limitations of the cited multi-institutional study does the commentary point out?

It notes the retrospective design with potential unobserved confounders, selection bias from a China-only cohort, and limited sample size across four centers, requiring larger studies.

Sep 21, 2026

Upload by Aria