Advertisement

Oncologic Outcomes of Patients With Resected T3N0M0 Non-small Cell Lung Cancer

      In the eighth edition TNM staging, the T3N0M0 category represents a heterogeneous group of non-small cell lung cancers (NSCLC). This study aims to compare the oncologic outcomes associated with individual T3 features. We performed a single-institution, retrospective analysis of 280 consecutive patients with pT3N0M0 NSCLC. Multivariate regression models were used to estimate associations of clinical factors with oncologic outcomes. The patients were grouped according to their T3 features into 4 prognostic groups: chest wall infiltration (CWI-PG), largest diameter >5 cm and ≤7 cm (Size-PG), presence of a satellite nodule (SN-PG), and all other T3 features. Overall survival (OS) and progression-free survival (PFS) were estimated using Kaplan-Meier and Cox proportional hazard analyses. Tumors were most often classified as T3N0M0 by size (156 patients, 55.7%), and the highest rate of incomplete resection occurred in patients with CWI (n = 7, 25.9%). In multivariate analysis, CWI (hazard ratio [HR] 2.45, 95% confidence interval [CI] 1.36, 4.44), incomplete resection (HR 3.01, 95% CI 1.29, 7.05), and age >65 (HR 1.6; 95% CI 1.08, 2.38) were independently associated with worse OS, and female sex was associated with better OS (HR 0.6, 95% CI 0.42, 0.87). The CWI-PG had poorer OS when compared with each of the other prognostic groups (P < 0.05), and the Size-PG had inferior OS when compared with the SN-PG (P = 0.039). This single-center study demonstrated significant differences in OS and PFS between patients with different T3 classifying features and suggest that further subdivision of the T3 category should be considered.

      Graphical abstract

      Keywords

      Abbreviations:

      CT (computed tomography), CWI (chest wall infiltration), CWI-PG (chest wall infiltration prognostic group), HR (hazard ratio), IASLC (International Association for the Study of Lung Cancer), IMS (invasive mediastinal staging), IUCPQ (Institut de Cardiologie et de Pneumologie de Québec), LN (lymph node), NSCLC (non-small cell lung cancer), OS (overall survival), Other-PG (all-other tumors prognostic group), PET (positron emission tomography), PFS (progression-free survival), PPI (parietal pleura infiltration), Size (tumor size >5 and ≤7 cm), Size-PG (tumor size >5 and ≤7 cm prognostic group), SN (satellite nodule), SN-PG (satellite nodule prognostic group), TNM (tumor-node-metastasis classification)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Seminars in Thoracic and Cardiovascular Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Goldstraw P
        • Chansky K
        • Crowley J
        • et al.
        The IASLC lung cancer staging project: Proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer.
        J Thorac Oncol. 2016; 11: 39-51
        • Rami-Porta R
        • Bolejack V
        • Crowley J
        • et al.
        The IASLC lung cancer staging project: Proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer.
        J Thorac Oncol. 2015; 10: 990-1003
        • McDonald F
        • De Waele M
        • Hendriks LE
        • et al.
        Management of stage I and II nonsmall cell lung cancer.
        Eur Respir J. 2017; 49
        • Postmus PE
        • Kerr KM
        • Oudkerk M
        • et al.
        Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol. 2017; 28 (iv1-iv21)
        • Scott WJ
        • Howington J
        • Movsas B
        American College of Chest P. Treatment of stage II non-small cell lung cancer.
        Chest. 2003; 123: 188S-201S
        • Lee CY
        • Byun CS
        • Lee JG
        • et al.
        The prognostic factors of resected non-small cell lung cancer with chest wall invasion.
        World J Surg Oncol. 2012; 10: 9
        • Jeon JH
        • Kim MS
        • Moon DH
        • et al.
        Prognostic differences in subgroups of patients with surgically resected T3 non-small cell lung cancer.
        Ann Thorac Surg. 2016; 102: 1630-1637
        • Yokoi K
        • Tsuchiya R
        • Mori T
        • et al.
        Results of surgical treatment of lung cancer involving the diaphragm.
        J Thorac Cardiovasc Surg. 2000; 120: 799-805
        • Douillard JY
        • Rosell R
        • De Lena M
        • et al.
        Adjuvant vinorelbine plus cisplatin versus observation in patients with completely resected stage IB-IIIA non-small-cell lung cancer (Adjuvant Navelbine International Trialist Association [ANITA]): A randomized controlled trial.
        Lancet Oncol. 2006; 7: 719-727
        • Choi Y
        • Lee IJ
        • Lee CY
        • et al.
        Multi-institutional analysis of T3 subtypes and adjuvant radiotherapy effects in resected T3N0 non-small cell lung cancer patients.
        Radiat Oncol J. 2015; 33: 75-82
        • Drake JA
        • Sullivan JL
        • Weksler B.
        Adjuvant chemotherapy improves survival in patients with completely resected T3N0 non-small cell lung cancer invading the chest wall.
        J Thorac Cardiovasc Surg. 2018; 155: 1794-1802
        • Salazar MC
        • Rosen JE
        • Arnold BN
        • et al.
        Adjuvant chemotherapy for T3 non-small cell lung cancer with additional tumor nodules in the same lobe.
        J Thorac Oncol. 2016; 11: 1090-1100
        • Magdeleinat P
        • Alifano M
        • Benbrahem C
        • et al.
        Surgical treatment of lung cancer invading the chest wall: Results and prognostic factors.
        Ann Thorac Surg. 2001; 71: 1094-1099
        • Gould PM
        • Bonner JA
        • Sawyer TE
        • et al.
        Patterns of failure and overall survival in patients with completely resected T3 N0 M0 non-small cell lung cancer.
        Int J Radiat Oncol Biol Phys. 1999; 45: 91-95
        • Lee HW
        • Lee CH
        • Park YS.
        Location of stage I-III non-small cell lung cancer and survival rate: Systematic review and meta-analysis.
        Thorac Cancer. 2018; 9: 1614-1622
        • Kawaguchi K
        • Miyaoka E
        • Asamura H
        • et al.
        Modern surgical results of lung cancer involving neighboring structures: A retrospective analysis of 531 pT3 cases in a Japanese Lung Cancer Registry Study.
        J Thorac Cardiovasc Surg. 2012; 144: 431-437
        • Midway S
        • Robertson M
        • Flinn S
        • et al.
        Comparing multiple comparisons: Practical guidance for choosing the best multiple comparisons test.
        PeerJ. 2020; 8: e10387
        • Matsuoka H
        • Nishio W
        • Okada M
        • et al.
        Resection of chest wall invasion in patients with non-small cell lung cancer.
        Eur J Cardiothorac Surg. 2004; 26: 1200-1204
        • Suzuki M
        • Yoshida S
        • Moriya Y
        • et al.
        Single T factors predict survival of patients with resected stage-IIB non-small-cell lung cancers.
        Eur J Cardiothorac Surg. 2011; 39: 745-748
        • Gao SJ
        • Corso CD
        • Blasberg JD
        • et al.
        Role of adjuvant therapy for node-negative lung cancer invading the chest wall.
        Clin Lung Cancer. 2017; 18 (e4): 169-177
        • Chiappetta M
        • Margaritora S
        • Facciolo F.
        T3 non-small cell lung cancer: Should multimodal therapy be different for each presentation?.
        Ann Thorac Surg. 2017; 103: 2026
        • Rao J
        • Sayeed RA
        • Tomaszek S
        • et al.
        Prognostic factors in resected satellite-nodule T4 non-small cell lung cancer.
        Ann Thorac Surg. 2007; 84 (discussion 9): 934-938
        • Bryant AS
        • Pereira SJ
        • Miller DL
        • et al.
        Satellite pulmonary nodule in the same lobe (T4N0) should not be staged as IIIB non-small cell lung cancer.
        Ann Thorac Surg. 2006; 82 (discussion 13-4): 1808-1813
        • Detterbeck FC
        • Marom EM
        • Arenberg DA
        • et al.
        The IASLC lung cancer staging project: Background data and proposals for the application of TNM staging rules to lung cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the TNM classification.
        J Thorac Oncol. 2016; 11: 666-680

      Linked Article

      • T3N0M0 NSCLC Subtypes - A Signal for Disparate Outcomes after Surgery
        Seminars in Thoracic and Cardiovascular Surgery
        • Preview
          The 8th edition of the TNM staging system for non-small cell lung cancer (NSCLC) was a leap forward from prior versions in stratifying the T-stage of small tumors.1 However, certain categories still remain more ambiguous than desired. The T3N0M0 stage (IIb) has been encompassing a heterogeneous group of locally advanced tumors with a variety of T3 defining features - namely, larger size (5-7 cm), invasion into some structures, and separate and/or ”satellite” nodules in the same lobe. Tumors with any of the T3 descriptors may be still amenable for a complete resection, which is the common ground for this stage, but the different features may also confer a disparate biologic behavior that could define their prognosis after surgery.
        • Full-Text
        • PDF