From the Department of Radiology and Research Institute of Radiology (N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Korea.
Radiol Cardiothorac Imaging. 2024 Aug;6(4):e230347. doi: 10.1148/ryct.230347.
Purpose To evaluate the preoperative risk factors in patients with pathologic IIIA N2 non-small cell lung cancer (NSCLC) who underwent upfront surgery and to evaluate the prognostic value of new N subcategories. Materials and Methods Patients with pathologic stage IIIA N2 NSCLC who underwent upfront surgery in a single tertiary center from January 2015 to April 2021 were retrospectively reviewed. Each patient's clinical N (cN) was assigned to one of six subcategories (cN0, cN1a, cN1b, cN2a1, cN2a2, and cN2b) based on recently proposed N descriptors. Cox regression analysis was used to identify the significant prognostic factors for recurrence-free survival (RFS) and overall survival (OS). Results A total of 366 patients (mean age ± SD, 62.0 years ± 10.1; 202 male patients [55%]) were analyzed. The recurrence rate was 55% (203 of 366 patients) over a median follow-up of 37.3 months. Multivariable analysis demonstrated that cN (hazard ratios [HRs] for cN1 and cN2b compared with cN0, 1.66 [95% CI: 1.11, 2.48] and 2.11 [95% CI: 1.32, 3.38], respectively) and maximum lymph node (LN) size at N1 station (≥12 mm; HR, 1.62 [95% CI: 1.15, 2.29]), in addition to clinical T category (HR, 1.51 [95% CI: 1.14, 1.99]), were independent prognostic factors for RFS. For OS, clinical N subcategories (cN1, cN2a2, and cN2b vs cN0; HRs, 1.91 [95% CI: 1.11, 3.27], 1.89 [95% CI: 1.13, 2.18], and 2.02 [95% CI: 1.07, 3.80], respectively) and LN size at N1 station (HR, 1.75 [95% CI: 1.12, 2.71]) were independent prognostic factors. For clinical N1, OS was further stratified according to LN size (log-rank test, < .001). Conclusion Assessing the proposed N subcategories by reporting single versus multistation involvement of N2 disease and maximum size of metastatic LN, reflecting metastatic burden, at preoperative CT may offer useful prognostic information for planning optimal treatment strategies. CT, Lung, Staging, Non-Small Cell Lung Cancer . ©RSNA, 2024.
目的 评估接受 upfront 手术的病理 IIIA N2 期非小细胞肺癌 (NSCLC) 患者的术前危险因素，并评估新 N 亚组的预后价值。
材料与方法 回顾性分析 2015 年 1 月至 2021 年 4 月期间在一家三级中心接受 upfront 手术的病理 IIIA N2 NSCLC 患者。根据最近提出的 N 描述符，每位患者的临床 N (cN) 被分配到六个亚组之一 (cN0、cN1a、cN1b、cN2a1、cN2a2 和 cN2b)。使用 Cox 回归分析确定无复发生存 (RFS) 和总生存 (OS) 的显著预后因素。
结果 共分析了 366 例患者(平均年龄 ± 标准差，62.0 岁 ± 10.1; 202 例男性[55%])。中位随访 37.3 个月时，复发率为 55%(203/366 例)。多变量分析表明，cN(与 cN0 相比，cN1 和 cN2b 的危险比 [HRs] 分别为 1.66 [95% CI：1.11，2.48]和 2.11 [95% CI：1.32，3.38])和 N1 站最大淋巴结 (LN) 大小(≥12 mm; HR，1.62 [95% CI：1.15，2.29])，以及临床 T 分期(HR，1.51 [95% CI：1.14，1.99])是 RFS 的独立预后因素。对于 OS，临床 N 亚组(cN1、cN2a2 和 cN2b 与 cN0; HRs，1.91 [95% CI：1.11，3.27]、1.89 [95% CI：1.13，2.18]和 2.02 [95% CI：1.07，3.80]，分别)和 N1 站 LN 大小(HR，1.75 [95% CI：1.12，2.71])是独立的预后因素。对于临床 N1，根据 LN 大小进一步分层 OS(对数秩检验，<.001)。
结论 通过报告术前 CT 中 N2 疾病的单站或多站受累和转移 LN 的最大大小，评估提出的 N 亚组，反映转移负担，可为规划最佳治疗策略提供有用的预后信息。
CT、肺、分期、非小细胞肺癌。
