Division of Thoracic Surgery, Sprott Department of Surgery, University Health Network, Toronto, Ontario, Canada; Department of Surgery, Clinica Alemana de Santiago, Universidad de Chile, Santiago, Chile.
Division of Thoracic Surgery, Sprott Department of Surgery, University Health Network, Toronto, Ontario, Canada.
J Thorac Cardiovasc Surg. 2022 Sep;164(3):629-636. doi: 10.1016/j.jtcvs.2022.02.015. Epub 2022 Feb 11.
The 8th TNM edition classifies stage III-N2 disease as IIIA and IIIB based on a tumor size cutoff of 5 cm. However, the importance of tumor size on survival in patients with resectable stage III-N2 disease has not been analyzed systematically.
Survival analysis based on tumor size (>5 cm vs ≤ 5 cm) for 255 consecutive patients with nonbulky (maximal lymph node diameter of 1.5 cm) stage III-N2 non-small cell lung cancer treated with surgery in our institution.
Ninety patients (35.3%) underwent induction chemoradiation therapy (n = 72, 28%) or induction chemotherapy (n = 18, 7%), and 165 patients underwent primary surgery followed by adjuvant chemotherapy (n = 52, 32%), adjuvant chemoradiation therapy (n = 47, 29%), or adjuvant radiation therapy (n = 14, 13.2%). After a median follow-up of 6.5 years, the overall survival was 46.5% at 5 years and 28.9% at 10 years. In tumors 5 cm or less, there was no difference in survival between patients treated with induction or adjuvant therapy. However, in tumors greater than 5 cm, the survival was significantly better after induction therapy compared with adjuvant therapy or surgery alone. Pathologic multi-station N2 disease was more frequently detected in tumors greater than 5 cm (31% vs 18% in tumors ≤5 cm, P = .042), and the rate of R1 resection was lower after induction therapy (2.2% vs 8.5% in primary surgery, P = .048).
These results support the redefinition of tumors greater than 5 cm with resectable N2 disease to stage IIIB. This change should help to refine the multimodality approach for stage III-N2 lung cancer.
第 8 版 TNM 分期基于肿瘤大小的截断值为 5cm 将 III-N2 期疾病分为 IIIA 和 IIIB。然而，在可切除的 III-N2 期疾病患者中，肿瘤大小对生存的重要性尚未系统分析。
对在我院接受手术治疗的 255 例非巨块（最大淋巴结直径为 1.5cm）III-N2 期非小细胞肺癌患者，根据肿瘤大小（＞5cm 与≤5cm）进行生存分析。
90 例患者（35.3%）接受了诱导放化疗（n=72，28%）或诱导化疗（n=18，7%），165 例患者接受了原发手术，然后接受了辅助化疗（n=52，32%）、辅助放化疗（n=47，29%）或辅助放疗（n=14，13.2%）。中位随访 6.5 年后，5 年总生存率为 46.5%，10 年总生存率为 28.9%。在肿瘤≤5cm 的患者中，诱导治疗与辅助治疗之间的生存无差异。然而，在肿瘤＞5cm 的患者中，与辅助治疗或单纯手术相比，诱导治疗后的生存明显更好。肿瘤＞5cm 时更常发现多站 N2 病理（31%比肿瘤≤5cm 时的 18%，P=0.042），诱导治疗后 R1 切除率较低（2.2%比原发手术的 8.5%，P=0.048）。
这些结果支持将可切除 N2 期疾病中＞5cm 的肿瘤重新定义为 IIIB 期。这一改变有助于完善 III-N2 期肺癌的多模式治疗方法。
