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: European Journal of Cardio-thoracic Surgery

M. Chiappetta, F. Lococo, G. Leuzzi, I. Sperduti, L. Petracca-Ciavarella, E. Bria, F. Mucilli, P.L. Filosso, G.B. Ratto, L. Spaggiari, F. Facciolo, S. Margaritora

Research output: Contribution to journalArticlepeer-review

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 (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.
Original languageEnglish
Pages (from-to)1236-1244
Number of pages9
JournalEur. J. Cardio-thorac. Surg.
Volume58
Issue number6
DOIs
Publication statusPublished - 2020

Keywords

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

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