Chiappetta Marco, Lococo Filippo, Leuzzi Giovanni, Sperduti Isabella, Petracca-Ciavarella Leonardo, Bria Emilio, Mucilli Felice, Filosso Pier Luigi, Ratto Giovanni Battista, Spaggiari Lorenzo, Facciolo Francesco, Margaritora Stefano
Università Cattolica del Sacro Cuore, Rome, Italy.
Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur J Cardiothorac Surg. 2020 Dec 1;58(6):1236-1244. doi: 10.1093/ejcts/ezaa215.
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.
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.
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 and ADJ. Finally, the 5-year-OS was statistically significant when we compared N2a1 with N2a2 of the total cohort (44.8% vs 32.8%, P = 0.04), in ADC (5-year-OS 50.6% vs 36.5%, P = 0.04) and #RN >10 (5-year-OS 49.8% vs 32.1%, P = 0.03) without ADJ.
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.
N1b（多个N1站）、N2a2（单个N2站+N1受累）和N2a1（跳跃性N2转移）的生存曲线重叠，限制了当前肿瘤-淋巴结-转移（TNM）分期系统中淋巴结（N）受累情况的分类。我们对外验证了所提出的分类方法。
回顾性分析了一个多中心数据库中的临床记录，该数据库包含1036例2002年1月至2014年12月期间接受全肺切除术的伴有N1/N2受累的肺腺癌（ADC）或鳞状细胞癌患者。根据第8版TNM分期系统中N分期的建议对患者进行分类。组织学类型、切除淋巴结数量（#RN）和辅助治疗（ADJ）被视为限制因素。
N1b和N2a1之间的5年总生存率（-OS）无差异（49.6%对44.8%，P = 0.72）；相反，鳞状细胞癌患者的5年总生存率显著提高（N1b中为63%，N2a1中为30.7%，P = 0.04）。在ADC患者中，N2a1患者的5年总生存率高于N1b患者（50.6%对37.5%，P = 0.09）。当我们比较N1b和N2a2时，5年总生存率有统计学意义（49.6%对32.8%，P = 0.02）；仅考虑鳞状细胞癌患者（63%对25.8%，P = 0.003）、#RN>10（63.2%对35.3%，P = 0.05）和未接受辅助治疗的患者（56.4%对24.5%，P = 0.02）时，5年总生存率有显著差异。对于ADC、#RN<10和辅助治疗，差异不显著。最后，当我们比较整个队列中的N2a1和N2a2时，5年总生存率有统计学意义（44.8%对32.8%，P = 0.04），在ADC患者中（5年总生存率50.6%对36.5%，P = 0.04）以及#RN>10且未接受辅助治疗患者中（5年总生存率49.8%对32.1%，P = 0.03）也是如此。
组织学类型、辅助治疗和#RN是N+非小细胞肺癌的相关预后因素。考虑到这些结果，我们可以更好地解释所提出的第8版TNM分期系统中N描述符的预后预测局限性。
