External validation of the N descriptor in the proposed tumour-node-metastasis subclassification for lung cancer: The crucial role of histological type, number of resected nodes and adjuvant therapy

Filippo Lococo, Emilio Bria, Stefano Margaritora, Giovanni Leuzzi, Isabella Sperduti, Felice Mucilli, Pier Luigi Filosso, Giovanni Battista Ratto, Lorenzo Spaggiari, Francesco Facciolo

Risultato della ricerca: Contributo in rivistaArticolo in rivista

2 Citazioni (Scopus)

Abstract

OBJECTIVES: Overlapping survival curves for N1b (multiple N1 stations), N2a2 (single N2 station + N1 involvement) and N2a1 (skip N2 metastasis) limit the current tumour-node-metastasis (TNM) node (N) subclassification for node involvement. We validated externally the proposed subclassification. METHODS: Clinical records from a multicentric database comprising 1036 patients with pulmonary adenocarcinoma (ADC) or squamous cell carcinoma with N1/N2 involvement who underwent, from January 2002 to December 2014, complete lung resections were retrospectively reviewed. Patients were categorized according to the 8th TNM N subclassification proposal. Histological type, number of resected nodes (#RN) and adjuvant therapy (ADJ) were considered limiting factors. RESULTS: No difference in the 5-year overall survival (-OS) was noted between N1b and N2a1 (49.6% vs 44.8%, P = 0.72); instead, the 5-year-OS was significantly improved in patients with squamous cell carcinoma (63% in N1b vs 30.7% in N2a1, P = 0.04). In patients with ADC, the 5-year-OS was better in those with N2a1 than with N1b (50.6% vs 37.5%, P = 0.09). When we compared N1b with N2a2, the 5-year-OS was statistically significant (49.6% vs 32.8%, P = 0.02); considering only patients with squamous cell carcinoma (63% vs 25.8%, P = 0.003), #RN >10 (63.2% vs 35.3%, P = 0.05) and without ADJ (56.4% vs 24.5%, P = 0.02), the 5-year-OS was significantly different. Differences were not significant for ADC, #RN <10 and ADJ. Finally, the 5-year-OS was statistically significant when we compared N2a1 with N2a2 of the total cohort (44.8% vs 32.8%, P = 0.04), in ADC (5-year-OS 50.6% vs 36.5%, P = 0.04) and #RN >10 (5-year-OS 49.8% vs 32.1%, P = 0.03) without ADJ. CONCLUSIONS: Histological type, ADJ and #RN are relevant prognostic factors in N + non-small-cell lung cancer. Considering these results, we may better interpret the prognosis prediction limits of the proposed 8th TNM subclassification for the N descriptor.
Lingua originaleEnglish
pagine (da-a)1236-1244
Numero di pagine9
RivistaEuropean Journal of Cardio-thoracic Surgery
Volume58
DOI
Stato di pubblicazionePubblicato - 2020

Keywords

  • Adenocarcinoma
  • Lung cancer
  • Lymph nodes
  • Staging
  • Surgery

Fingerprint

Entra nei temi di ricerca di 'External validation of the N descriptor in the proposed tumour-node-metastasis subclassification for lung cancer: The crucial role of histological type, number of resected nodes and adjuvant therapy'. Insieme formano una fingerprint unica.

Cita questo