Department of Pathology, OLVG, Amsterdam, The Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands.
J Thorac Oncol. 2019 Mar;14(3):459-467. doi: 10.1016/j.jtho.2018.10.164. Epub 2018 Nov 5.
The objective was to study outcomes in patients in a population registry who were surgically staged as having pT3N0 NSCLC according to the seventh and eighth editions of the TNM staging classification.
Details of patients who underwent surgery for NSCLC staged as pT3N0M0 from 2010 to 2013 on the basis of the seventh edition of the TNM classification were retrieved from the Netherlands Comprehensive Cancer Organization. These data were next matched with corresponding pathology data from a nationwide registry. Patients were categorized into four major pT3 subgroups as follows: those with a tumor diameter more than 7 cm, those with separate tumor nodules in the same lobe (two or more nodules), those with parietal pleural invasion, and a mixed group (consisting mainly of those with a tumor diameter larger than 7 cm combined with parietal pleural invasion).
A total of 683 patients were eligible for analysis. The 3- and 5-year overall survival (OS) rates for the subtype tumor diameter larger than 7 cm were 59.9% and 47.2%, respectively, and were comparable to the rates for the subtype with pleural invasion (50.4% and 45.3%), respectively. The mixed group had worse 3- and 5-year OS rates (37.5% and 28.7%, respectively), which were comparable to the outcomes for TNM eighth edition-staged IIIB and pT4 cases in the International Association for the Study of Lung Cancer database. For the subtype two or more nodules, the 3- and 5-year OS rates were 70.6% and 62.8%, respectively, with patients with adenocarcinoma showing a significantly better OS than did patients with squamous cell carcinoma: a 5-year OS rate of 65.1% versus 47.2%, respectively (p < 0.001), suggesting that the prognosis for the adenocarcinoma subgroup may be comparable to that for the pT2 category, whereas squamous cell carcinoma nodules can remain pT3.
This population analysis of overall survival rate by pT3N0 subcategory for NSCLC suggests that histologic type is a relevant descriptor in the category two or more nodules. The findings do not support migration of the group with a tumor diameter larger than 7 cm to the category pT4in the eighth edition of the TNM classification, and they suggest that a combination of two pT3 descriptors (the mixed group) merits migration to pT4.
本研究旨在探讨根据第七版和第八版 TNM 分期分类，在人群登记处被手术分期为 pT3N0 NSCLC 的患者的结局。
从荷兰综合癌症组织检索了 2010 年至 2013 年期间基于第七版 TNM 分类标准接受手术治疗的 pT3N0M0 期非小细胞肺癌患者的详细资料。这些数据随后与全国性登记处的相应病理数据相匹配。患者被分为四个主要的 pT3 亚组：肿瘤直径大于 7cm 的患者、同一肺叶内有单独肿瘤结节（两个或更多结节）的患者、壁层胸膜侵犯的患者以及混合组（主要由肿瘤直径大于 7cm 合并壁层胸膜侵犯的患者组成）。
共有 683 名患者符合分析条件。肿瘤直径大于 7cm 亚组的 3 年和 5 年总生存率（OS）分别为 59.9%和 47.2%，与壁层胸膜侵犯亚组（分别为 50.4%和 45.3%）相当。混合组的 3 年和 5 年 OS 率较差（分别为 37.5%和 28.7%），与国际肺癌研究协会数据库中第八版 TNM 分期的 IIIB 和 pT4 病例的结果相当。对于两个或更多结节亚组，3 年和 5 年 OS 率分别为 70.6%和 62.8%，腺癌患者的 OS 明显优于鳞癌患者：5 年 OS 率分别为 65.1%和 47.2%（p<0.001），提示腺癌亚组的预后可能与 pT2 类别相当，而鳞癌结节仍可保持 pT3。
本研究通过 NSCLC 的 pT3N0 亚组分析总生存率，提示组织学类型是两个或更多结节亚组的一个相关描述符。研究结果不支持将直径大于 7cm 的肿瘤亚组转移到第八版 TNM 分类的 pT4 类别，并且表明两个 pT3 描述符（混合组）的组合值得转移到 pT4。
