TY - JOUR
T1 - 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
T2 - European Journal of Cardio-thoracic Surgery
AU - Chiappetta, M.
AU - Lococo, F.
AU - Leuzzi, G.
AU - Sperduti, I.
AU - Petracca-Ciavarella, L.
AU - Bria, E.
AU - Mucilli, F.
AU - Filosso, P.L.
AU - Ratto, G.B.
AU - Spaggiari, L.
AU - Facciolo, F.
AU - Margaritora, S.
N1 - Cited By :1
Export Date: 2 March 2021
CODEN: EJCSE
Correspondence Address: Lococo, F.; Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, Italy; email: filippo.lococo@policlinicogemelli.it
Funding text 1: The authors would like to thank Franziska M. Lohmeyer for her support revising our manuscript and Maria Chiara Cannizzaro (Medical Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy) for her support in data curation revising our manuscript.
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PY - 2020
Y1 - 2020
N2 - 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 (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. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
AB - 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 (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. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
KW - Adenocarcinoma
KW - Lung cancer
KW - Lymph nodes
KW - Staging
KW - Surgery
U2 - 10.1093/ejcts/ezaa215
DO - 10.1093/ejcts/ezaa215
M3 - Article
VL - 58
SP - 1236
EP - 1244
JO - Eur. J. Cardio-thorac. Surg.
JF - Eur. J. Cardio-thorac. Surg.
SN - 1010-7940
IS - 6
ER -