THORACIC – Original Submission|Articles in Press

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



      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)
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      Linked Article

      • T3N0M0 NSCLC Subtypes - A Signal for Disparate Outcomes after Surgery
        Seminars in Thoracic and Cardiovascular Surgery
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          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.
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