Chen Tao, Zhong Yifan, Wen Jialiang, Deng Jiajun, She Yunlang, Zhu Yuming, Chen Qiankun, Wu Chunyan, Hou Likun, Jiang Lei, Chen Chang
Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
JTO Clin Res Rep. 2023 Sep 14;4(10):100574. doi: 10.1016/j.jtocrr.2023.100574. eCollection 2023 Oct.
To validate the residual tumor (R) classification proposed by the International Association for the Study of Lung Cancer (IASLC) in NSCLC after sleeve lobectomy.
A total of 682 patients were analyzed. The R status, on the basis of the Union for International Cancer Control (UICC) criteria, was recategorized according to the IASLC descriptors. Recurrence-free survival (RFS) and overall survival (OS) among different R classifications were assessed for the entire cohort and pathologic node (pN) subgroups.
All in all, 631 (92.5%), 48 (7.1%), and three patients (0.4%) were classified as R0, R1, and R2, respectively, by the UICC criteria, whereas 489 (71.7%), 110 (16.1%), and 83 patients (12.2%), received R0, uncertain resection (R[un]), and R1/2 resection, respectively, according to the IASLC criteria. There were 96 patients (15.2%) with UICC R0 who were reclassified as R(un), mainly because of the positive highest mediastinal node station (82 of 96, 85.4%). A total of 46 patients (7.3%) were reassigned from UICC R0 to IASLC R1/2 owing to extracapsular extension. For the entire cohort, patients with R(un) and R1/2 exhibited worse RFS (R[un], adjusted = 0.023; R1/2, adjusted = 0.001) and OS (R[un], adjusted = 0.040; R1/2, adjusted = 0.051) compared with R0. No significant differences were observed between R(un) and R1/2 (RFS, adjusted = 0.586; OS, adjusted = 0.781). Furthermore, subgroup analysis revealed a distinct prognostic impact of the IASLC R status-with prognostic significances in the pN1 and pN2 subgroups, but not in the pN0 subgroup.
The IASLC R descriptors helped to stratify the prognosis of NSCLC after sleeve lobectomy, with its prognostic impact varied among pN stages.
验证国际肺癌研究协会（IASLC）提出的非小细胞肺癌（NSCLC）袖式肺叶切除术后残留肿瘤（R）分类。
共分析682例患者。根据国际癌症控制联盟（UICC）标准确定的R状态，按照IASLC的描述重新分类。评估整个队列以及病理淋巴结（pN）亚组中不同R分类的无复发生存期（RFS）和总生存期（OS）。
总体而言，根据UICC标准，分别有631例（92.5%）、48例（7.1%）和3例患者（0.4%）被分类为R0、R1和R2，而根据IASLC标准，分别有489例（71.7%）、110例（16.1%）和83例患者（12.2%）接受了R0、不确定切除（R[un]）和R1/2切除。有96例（15.2%）UICC R0患者被重新分类为R（un），主要原因是最高纵隔淋巴结站阳性（96例中的82例，85.4%）。共有46例（7.3%）患者因包膜外侵犯从UICC R0重新分类为IASLC R1/2。对于整个队列，与R0相比，R（un）和R1/2患者的RFS（R[un]，校正后=0.023；R1/2，校正后=0.001）和OS（R[un]，校正后=0.040；R1/2，校正后=0.051）较差。R（un）和R1/2之间未观察到显著差异（RFS，校正后=0.586；OS，校正后=0.781）。此外，亚组分析显示IASLC R状态具有明显的预后影响——在pN1和pN2亚组中有预后意义，但在pN0亚组中没有。
IASLC的R描述有助于对NSCLC袖式肺叶切除术后的预后进行分层，其预后影响在pN分期中有所不同。
