Baum Philip, Taber Samantha, Erdmann Stella, Muley Thomas, Kriegsmann Mark, Christopoulos Petros, Thomas Michael, Winter Hauke, Pfannschmidt Joachim, Eichhorn Martin E
Department of Thoracic Surgery, Thoraxklinik, Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany.
Department of Thoracic Surgery, Heckeshorn Lung Clinic, Helios Klinikum Emil von Behring, Walterhöferstraße 11, 14165 Berlin, Germany.
Cancers (Basel). 2021 Apr 10;13(8):1812. doi: 10.3390/cancers13081812.
The current pT3N0 category represents a heterogeneous subgroup involving tumor size, separate tumor nodes in one lobe, and locoregional growth pattern. We aim to validate outcomes according to the eighth edition of the TNM staging classification. A total of 281 patients who had undergone curative lung cancer surgery staged with TNM-7 in two German centers were retrospectively analyzed. The subtypes tumor size >7 cm and multiple nodules were grouped as T3a, and the subtypes parietal pleura invasion and mixed were grouped as T3b. We stratified survival by subtype and investigated the relative benefit of adjuvant chemotherapy according to subtype. The 5-year overall survival (OS) rates differed between the different subtypes tumor diameter >7 cm (71.5%), multiple nodules in one lobe (71.0%) (grouped as T3a), parietal pleura invasion (59.%), and mixed subtype (5-year OS 50.3%) (grouped as T3b), respectively. The cohort as a whole did not gain significant OS benefit from adjuvant chemotherapy. In contrast, adjuvant chemotherapy significantly improved OS in the T3b subgroup (logrank = 0.03). This multicenter cohort analysis of pT3N0 patients identifies a new prognostic mixed subtype. Tumors >7 cm should not be moved to pT4. Patients with T3b tumors have significantly worse survival than patients with T3a tumors.
目前的pT3N0类别代表了一个异质性亚组，涉及肿瘤大小、一个肺叶内的独立肿瘤结节以及局部区域生长模式。我们旨在根据第八版TNM分期分类来验证预后情况。对德国两个中心共281例行根治性肺癌手术且按照TNM-7分期的患者进行了回顾性分析。肿瘤大小>7 cm和多发结节的亚型归为T3a，脏层胸膜侵犯和混合型的亚型归为T3b。我们按亚型对生存率进行分层，并根据亚型研究辅助化疗的相对获益情况。不同亚型的5年总生存率（OS）有所不同，肿瘤直径>7 cm的为71.5%，一个肺叶内多发结节的为71.0%（归为T3a），脏层胸膜侵犯的为59%，混合型的（5年OS为50.3%）归为T3b。整个队列未从辅助化疗中获得显著的OS获益。相比之下，辅助化疗显著改善了T3b亚组的OS（对数秩检验P = 0.03）。这项对pT3N0患者的多中心队列分析确定了一种新的预后混合型亚型。肿瘤>7 cm不应归为pT4。T3b肿瘤患者的生存率显著低于T3a肿瘤患者。
