Thoracic Surgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey; Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Ann Thorac Surg. 2021 Nov;112(5):1656-1663. doi: 10.1016/j.athoracsur.2020.10.033. Epub 2020 Nov 26.
Treatment of stage IIIA lung cancer remains controversial because it includes a very heterogeneous group of patients. The purpose of our study was to compare survival between stage IIIA subsets and to externally validate our results with another center's database.
Patients with completely resected stage IIIA/B lung cancer were retrospectively analyzed. There were 424 patients with stage IIIA and 82 patients with stage IIIB (T3/4 N2) (study cohort). Stage IIIA was divided into 2 subsets according to the tumor localization and tumor size (T3 N1-T4 N0/1, IIIA-T group; n = 308) and the extension of nodal disease (T1/2 N2, IIIA-N2 group; n = 116). The study cohort results were used to create a model for stage IIIA patients, which was validated with another center's database (validation cohort).
The multivariate analyses showed age, stage IIIB, and pN2 were independent negative prognostic factors (P < .0001). Survival at 5 years was 51.3% (median, 64 months) for patients in the IIIA-T group and was 25.7% (median, 31 months) in the IIIA-N2 patients (hazard ratio, 1.834; P < .0001). There was no statistical difference in survival between the IIIA-N2 and stage IIIB groups (25.7% vs 25.3%, P = .442). The created model was performed on patients in the validation cohort as a model IIIA-T (T3 N1-T4 N0/1, n = 139) and model IIIA-N2 (T1/2 N2, n = 104). Model IIIA-T patients had a statistically better survival rate than model IIIA-N2 patients (median, 62 months vs 37 months; hazard ratio, 1.707, P < 0.001).
There is a prognostic difference between stage IIIA subgroups in lung cancer patients who undergo surgical treatment.
III 期 A 肺癌的治疗仍存在争议，因为它包含了一组非常异质的患者。我们的研究目的是比较 IIIA 亚组之间的生存情况，并通过另一个中心的数据库来验证我们的结果。
回顾性分析完全切除的 IIIA/B 期肺癌患者。共有 424 例 IIIA 期患者和 82 例 IIIB 期（T3/4 N2）患者（研究队列）。根据肿瘤定位和肿瘤大小（T3 N1-T4 N0/1，IIIA-T 组；n=308）和淋巴结疾病的扩展（T1/2 N2，IIIA-N2 组；n=116）将 IIIA 期分为 2 个亚组。使用研究队列的结果创建一个 IIIA 期患者的模型，并使用另一个中心的数据库进行验证（验证队列）。
多因素分析显示，年龄、IIIB 期和 pN2 是独立的预后不良因素（P<0.0001）。IIIA-T 组患者的 5 年生存率为 51.3%（中位，64 个月），IIIA-N2 组患者为 25.7%（中位，31 个月）（风险比，1.834；P<0.0001）。IIIA-N2 组和 IIIB 组之间的生存无统计学差异（25.7%比 25.3%，P=0.442）。在验证队列中，为患者创建了模型 IIIA-T（T3 N1-T4 N0/1，n=139）和模型 IIIA-N2（T1/2 N2，n=104）。模型 IIIA-T 患者的生存率明显优于模型 IIIA-N2 患者（中位，62 个月比 37 个月；风险比，1.707，P<0.001）。
在接受手术治疗的肺癌患者中，III 期亚组之间存在预后差异。
