Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom.
Cancer Research And Biostatistics, Seattle, Washington.
J Thorac Oncol. 2020 Mar;15(3):344-359. doi: 10.1016/j.jtho.2019.10.019. Epub 2019 Nov 13.
Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un).
A total of 14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: whether fewer than three N2 stations were explored, lobe-specific nodal dissection, extracapsular extension, highest lymph node station status, carcinoma in situ at the bronchial resection margin, and pleural lavage cytologic examination result. Revised categories of R0, R(un), R1, and R2 were tested for survival impact.
In all, 14,293 cases were R0, 263 were R1, and 156 were R2 (median survivals not reached, 33 months, and 29 months, respectively). R status correlated with T and N categories. A total of 9290 cases (63%) had three or more N2 stations explored and 6641 cases (45%) had lobe-specific nodal dissection, correlated with increasing pN2. Extracapsular extension was present in 62 of 364 cases with available data (17%). The highest station was positive in 942 cases (6.4%). The pleural lavage cytologic examination result was positive in 59 of 1705 cases (3.5%): 13 had carcinoma in situ at the bronchial resection margin. After reassignment because of inadequate nodal staging in 56% of cases, 6070 cases were R0, 8185 were R(un), 301 were R1, and 156 were R2. In node-positive cases, the median survival times were 70, 50, and 30 months for R0, R(un) (p < 0.0001), and R1 (p < 0.001), respectively, with no significant difference between R0 and R(un) in pN0 cases.
R descriptors have prognostic relevance, with R(un) survival stratifying between R0 and R1. Therefore, a detailed evaluation of R factor is of particular importance in the design and analyses of clinical trials of adjuvant therapies.
我们旨在验证 NSCLC 中潜在残余肿瘤（R）描述符的预后相关性，包括国际肺癌研究协会提出的不确定切除的定义，称为 R(un)。
分析了 14712 例接受完整 R 状态和生存评估的患者。还评估了以下因素：是否探查少于三个 N2 站、肺叶特异性淋巴结清扫、外膜侵犯、最高淋巴结站状态、支气管切缘原位癌和胸腔灌洗细胞学检查结果。测试了 R0、R(un)、R1 和 R2 的修订类别对生存的影响。
共有 14293 例为 R0，263 例为 R1，156 例为 R2（中位生存期未达到，分别为 33 个月和 29 个月）。R 状态与 T 和 N 分类相关。共有 9290 例（63%）探查了三个或更多 N2 站，6641 例（45%）进行了肺叶特异性淋巴结清扫，与 pN2 增加相关。有 364 例中 62 例（17%）存在外膜侵犯。最高淋巴结站阳性 942 例（6.4%）。胸腔灌洗细胞学检查阳性 1705 例中的 59 例（3.5%）：13 例支气管切缘有原位癌。由于 56%的病例淋巴结分期不足进行重新分类后，6070 例为 R0，8185 例为 R(un)，301 例为 R1，156 例为 R2。在淋巴结阳性的病例中，R0、R(un)（p<0.0001）和 R1（p<0.001）的中位生存时间分别为 70、50 和 30 个月，而在 pN0 病例中，R0 和 R(un)之间无显著差异。
R 描述符具有预后相关性，R(un)的生存分层在 R0 和 R1 之间。因此，在辅助治疗临床试验的设计和分析中，详细评估 R 因素尤为重要。
