Chen Yiyong, Zhang Juan, Chen Jing, Yang Zijie, Ding Yun, Chen Wenshu, Guo Tianxing, Zhao Lilan, Pan Xiaojie
Shengli Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China.
Department of Pharmacy, Fujian Children's Hospital, Fuzhou, Fujian, China.
Front Oncol. 2023 Jan 4;12:1082850. doi: 10.3389/fonc.2022.1082850. eCollection 2022.
The impact of rib invasion on the non-small cell lung cancer (NSCLC) T classifications remains unclear. Our study aims to verify the impact of rib invasion on survival in patients with NSCLC through multicenter data from the Surveillance, Epidemiology, and End Results (SEER) database, and proposed a more appropriate pT for the forthcoming 9 tumor-node-metastasis (TNM) classifications.
The SEER database was used to collect TNM NSCLC cases from the period of 2010-2015 according to the 7 TNM classification system. Subsequently, the T classification was restaged according to the 8 TNM classification system based on the following codes: tumor size and tumor extension. Cases with T1-2 disease and incomplete clinicopathological information were excluded. Finally, 6479 T3 and T4 NSCLC patients were included in the present study and divided into a rib invasion group (n = 131), other pT3 group (n = 3835), and pT4 group (n = 2513). Propensity-score matching (PSM) balanced the known confounders of the prognosis, resulting in two sets (rib invasion group other pT3 and pT4 group). Overall survival (OS) and cancer-specific survival (CSS) were investigated using Kaplan-Meier survival curves, and predictive factors of OS and CSS were assessed by Cox regression.
Survival outcomes of the rib invasion group were worse than the other pT3 group (OS: 40.5% . 46.5%, p = 0.035; CSS: 49.2% . 55.5%, p = 0.047), but comparable to the pT4 group (OS: 40.5% . 39.9%, p = 0.876; CSS: 49.2% . 46.3%, p = 0.659). Similar results were obtained after PSM. Multivariate analyses for all patients revealed that age at diagnosis, gender, N stage, T stage, surgical modalities, and adjuvant therapy had a predictive value for the prognosis.
The rib invasion group had a worse prognosis than the other pT3 groups, but was similar to the pT4 group. Our recommendation is to change the classification of rib invasion to pT4 disease and further validate this in the forthcoming 9 TNM classification.
肋骨侵犯对非小细胞肺癌（NSCLC）T分类的影响尚不清楚。我们的研究旨在通过监测、流行病学和最终结果（SEER）数据库的多中心数据，验证肋骨侵犯对NSCLC患者生存的影响，并为即将推出的第9版肿瘤-淋巴结-转移（TNM）分类提出更合适的pT分类。
根据第7版TNM分类系统，使用SEER数据库收集2010 - 2015年期间的TNM NSCLC病例。随后，根据肿瘤大小和肿瘤扩展等编码，按照第8版TNM分类系统对T分类进行重新分期。排除T1-2期疾病且临床病理信息不完整的病例。最终，本研究纳入6479例T3和T4期NSCLC患者，并分为肋骨侵犯组（n = 131）、其他pT3组（n = 3835）和pT4组（n = 2513）。倾向评分匹配（PSM）平衡了预后的已知混杂因素，得到两组（肋骨侵犯组与其他pT3和pT4组）。使用Kaplan-Meier生存曲线研究总生存（OS）和癌症特异性生存（CSS），并通过Cox回归评估OS和CSS的预测因素。
肋骨侵犯组的生存结果比其他pT3组差（OS：40.5%对46.5%，p = 0.035；CSS：49.2%对55.5%，p = 0.047），但与pT4组相当（OS：40.5%对39.9%，p = 0.876；CSS：49.2%对46.3%，p = 0.659）。PSM后得到类似结果。对所有患者的多因素分析显示，诊断年龄、性别、N分期、T分期、手术方式和辅助治疗对预后有预测价值。
肋骨侵犯组的预后比其他pT3组差，但与pT4组相似。我们建议将肋骨侵犯的分类改为pT4期疾病，并在即将推出的第9版TNM分类中进一步验证这一点。
