Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Lung Cancer. 2021 Sep;159:27-33. doi: 10.1016/j.lungcan.2021.07.010. Epub 2021 Jul 21.
To evaluate the prognosis between patients with non-small cell lung cancer (NSCLC) invading difference depth of chest wall and estimate the impact of rib invasion on the pathological T classifications (pT).
We retrospectively evaluated 521 patients with resected pT3-4 NSCLC. Propensity-score matching (PSM) balanced the known confounders of the prognosis, resulting in two sets (rib invasion vs the pT3 and pT4 group). Recurrence-free survival (RFS) and Overall survival (OS) was assessed by Cox regression and Kaplan-Meier methods. Time-dependent receiver operating characteristic (ROC) curves were used to assess the additional benefit for survival prediction after reclassifying rib invasion cases.
Chest wall invasion occurred in 171 patients (62 rib invasion, 51 parietal pleural invasion [PL3] and 58 soft tissue invasion). Rib invasion was found to be an independent prognostic factor for both RFS (p = 0.006) and OS (p < 0.001) of pT3-4 NSCLC. The survival of rib invasion group was the worst (RFS: 13.1%; OS: 19.8%), followed by PL3 (RFS: 34.2%, P = 0.001; OS: 48.8%; p < 0.001) and the soft tissue invasion group (RFS: 40.6%, p = 0.001; OS: 57.7%, p < 0.001). Besides, the prognosis of rib invasion group was also found to be worse than those of pT3 (RFS: p < 0.001; OS: p < 0.001) and pT4 group (RFS: p = 0.002; OS: p < 0.001). After PSM, the 5-year RFS rate of rib invasion group were still lower than that of pT3 and pT4 group (p < 0.001); the 5-year OS rate of rib invasion was similar with that of pT4 group (p = 0.066) but lower than that of pT3 group (p = 0.014). The time-dependent ROC curves demonstrated that reclassifying rib invasion as pT4 disease provided an additional benefit for survival prediction (p < 0.001).
The rib invasion group had a worse prognosis than the PL3 and pT3 groups. The prognostic impact of rib invasion should be further validated as a pT4 disease in the TNM classification.
评估非小细胞肺癌（NSCLC）侵犯不同胸壁深度的患者的预后，并估计肋骨侵犯对病理 T 分类（pT）的影响。
我们回顾性评估了 521 例接受切除治疗的 pT3-4 NSCLC 患者。倾向评分匹配（PSM）平衡了预后的已知混杂因素，从而产生了两组（肋骨侵犯与 pT3 和 pT4 组）。通过 Cox 回归和 Kaplan-Meier 方法评估无复发生存率（RFS）和总生存率（OS）。时间依赖性接受者操作特征（ROC）曲线用于评估重新分类肋骨侵犯病例后对生存预测的额外益处。
171 例患者发生胸壁侵犯（62 例肋骨侵犯、51 例胸膜侵犯[PL3]和 58 例软组织侵犯）。肋骨侵犯是 pT3-4 NSCLC 患者 RFS（p=0.006）和 OS（p<0.001）的独立预后因素。肋骨侵犯组的生存最差（RFS：13.1%；OS：19.8%），其次是 PL3 组（RFS：34.2%，p=0.001；OS：48.8%，p<0.001）和软组织侵犯组（RFS：40.6%，p=0.001；OS：57.7%，p<0.001）。此外，肋骨侵犯组的预后也比 pT3 组（RFS：p<0.001；OS：p<0.001）和 pT4 组（RFS：p=0.002；OS：p<0.001）更差。PSM 后，肋骨侵犯组的 5 年 RFS 率仍低于 pT3 和 pT4 组（p<0.001）；肋骨侵犯组的 5 年 OS 率与 pT4 组相似（p=0.066），但低于 pT3 组（p=0.014）。时间依赖性 ROC 曲线表明，将肋骨侵犯重新分类为 pT4 疾病可提高生存预测的额外益处（p<0.001）。
肋骨侵犯组的预后比 PL3 组和 pT3 组差。肋骨侵犯的预后影响应进一步验证为 TNM 分类中的 pT4 疾病。
