Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea.
Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health. Baltimore, MD.
Ann Surg. 2023 Jun 1;277(6):e1355-e1363. doi: 10.1097/SLA.0000000000005414. Epub 2022 Feb 15.
The aim of this study was to validate the International Association for the Study of Lung Cancer (IASLC) residual tumor classification in patients with stage III-N2 non-small cell lung cancer (NSCLC) undergoing neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by surgery.
As adequate nodal assessment is crucial for determining prognosis in patients with clinical N2 NSCLC undergoing nCCRT followed by surgery, the new classification may have better prognostic implications.
Using a registry for thoracic cancer surgery at a tertiary hospital in Seoul, Korea, between 2003 and 2019, we analyzed 910 patients with stage III-N2 NSCLC who underwent nCCRT followed by surgery. We classified resections using IASLC criteria: complete (R0), uncertain (R[un]), and incomplete resection (R1/R2). Recurrence and mortality were compared using adjusted subdistribution hazard model and Cox-proportional hazards model, respectively.
Of the 96.3% (n = 876) patients who were R0 by Union for International Cancer Control (UICC) criteria, 34.5% (n = 3O2) remained R0 by IASLC criteria and 37.6% (n = 329) and 28% (n = 245) migrated to R(un) and R1, respectively. Most of the migration from UICC-R0 to lASLC-R(un) and IASLC-R1/R2 occurred due to inadequate nodal assessment (85.5%) and extracapsular nodal extension (77.6%), respectively. Compared to R0, the adjusted hazard ratios in R(un) and R1/R2 were 1.20 (95% confidence interval, 0.94-1.52), 1.50 (1.17-1.52) ( P fortrend = .001) for recurrence and 1.18 (0.93-1.51) and 1.51 (1.17-1.96) for death ( P for trend = .002).
The IASLC R classification has prognostic relevance in patients with stage III-N2 NSCLC undergoing nCCRT followed by surgery. The IASLC classification will improve the thoroughness of intraoperative nodal assessment and the completeness of resection.
本研究旨在验证国际肺癌研究协会（IASLC）在接受新辅助同步放化疗（nCCRT）后接受手术的 III 期 N2 非小细胞肺癌（NSCLC）患者中对残余肿瘤的分类。
由于对接受 nCCRT 后接受手术的临床 N2 NSCLC 患者进行充分的淋巴结评估对确定预后至关重要，因此新分类可能具有更好的预后意义。
使用韩国首尔一家三级医院胸科癌症手术登记处，我们分析了 2003 年至 2019 年间接受 nCCRT 后接受手术的 910 例 III 期 N2 NSCLC 患者。我们使用 IASLC 标准对切除物进行分类：完全（R0）、不确定（R[un]）和不完全（R1/R2）切除。使用调整后的亚分布风险模型和 Cox 比例风险模型分别比较复发和死亡。
在符合国际抗癌联盟（UICC）标准的 96.3%（n=876）患者中，34.5%（n=302）仍符合 IASLC 标准的 R0，37.6%（n=329）和 28%（n=245）分别迁移至 R[un]和 R1。UICC-R0 向 IASLC-R[un]和 IASLC-R1/R2 的大多数迁移归因于淋巴结评估不足（85.5%）和囊外淋巴结扩展（77.6%）。与 R0 相比，R[un]和 R1/R2 的调整后的风险比分别为 1.20（95%置信区间，0.94-1.52）和 1.50（1.17-1.52）（P趋势=0.001），复发风险分别为 1.18（0.93-1.51）和 1.51（1.17-1.96）（P趋势=0.002）。
IASLC R 分类在接受 nCCRT 后接受手术的 III 期 N2 NSCLC 患者中具有预后意义。IASLC 分类将提高术中淋巴结评估的彻底性和切除的完整性。
