Department of Thoracic Surgery, Ganzhou Tumor Hospital, Ganzhou, People's Republic of China.
Clin Respir J. 2023 Sep;17(9):941-950. doi: 10.1111/crj.13683. Epub 2023 Aug 7.
We aimed to explore the prognostic differences among T1-4N0-2M0 non-small cell lung cancer (NSCLC) patients with bronchus involvements and to validate the T category of these patients in an external cohort.
Univariable and multivariable Cox analysis was performed to determine the prognostic factors. Kaplan-Meier method with a log-rank test was used to compare overall survival differences between groups. Propensity score matching method was used to minimize the bias caused by the imbalanced covariates between groups.
A total of 169 390 eligible T1-4N0-2M0 NSCLC cases were included. There were 2354, 3367, 1638, 75, 87 585, 42 056, 19 246, and 13 069 cases in the group of superficial tumors of any size with invasive component limited to bronchial wall (T1-bronchus), tumors involving main stem bronchus ≥2 cm from carina (T2-main bronchus [≥2 cm]), tumors involving main stem bronchus <2 cm from carina (T2-main bronchus [<2 cm]), tumors with carina invasion (T4-carina), T1, T2, T3, and T4, respectively. Multivariable Cox analysis indicated that T1-bronchus patients had the best prognosis; T2-main bronchus (≥2 cm) and T2-main bronchus (<2 cm) patients had similar prognosis both in the entire cohort and in several subgroups. Survival curves showed that T1-bronchus and T1 patients had similar survival rates; the survivals of T2-main bronchus patients regardless of the distance from carina were comparable to those of T2 patients, and the survivals of T4-carina patients were also similar to those of T4 patients.
Our results validated and supported the current T category for the patients with bronchus involvements, which might provide certain reference value for the revisions of T category in the next version of the tumor-node-metastasis stage classification.
本研究旨在探讨累及支气管的 T1-4N0-2M0 非小细胞肺癌（NSCLC）患者的预后差异，并在外部队列中验证这些患者的 T 分期。
采用单变量和多变量 Cox 分析确定预后因素。采用 Kaplan-Meier 法和对数秩检验比较组间总生存差异。采用倾向评分匹配法最小化组间不平衡协变量引起的偏倚。
共纳入 169390 例符合条件的 T1-4N0-2M0 NSCLC 患者。其中，大小不限但浸润局限于支气管壁的表浅肿瘤（T1-支气管）、隆突下 2cm 以上主支气管累及（T2-主支气管[>2cm]）、隆突下 2cm 以内主支气管累及（T2-主支气管[<2cm]）、隆突受侵（T4-隆突）、T1、T2、T3 和 T4 患者分别有 2354、3367、1638、75、87585、42056、19246 和 13069 例。多变量 Cox 分析表明，T1-支气管患者预后最佳；T2-主支气管（>2cm）和 T2-主支气管（<2cm）患者在全队列和多个亚组中均具有相似的预后。生存曲线显示，T1-支气管和 T1 患者的生存率相似；无论距离隆突远近，T2-主支气管患者的生存率均与 T2 患者相当，T4-隆突患者的生存率与 T4 患者也相似。
本研究结果验证并支持了当前支气管受累患者的 T 分期，为肿瘤-淋巴结-转移（TNM）分期的下一个版本中 T 分期的修订提供了一定的参考价值。
