Houda Ilias, Bahce Idris, Dickhoff Chris, Kroese Tiuri E, Kroeze Stephanie G C, Mariolo Alessio V, Tagliamento Marco, Moliner Laura, Brandão Mariana, Pretzenbacher Yassin, Edwards John, Opitz Isabelle, Brunelli Alessandro, Guckenberger Matthias, van Schil Paul E, Popat Sanjay, Blum Torsten, Faivre-Finn Corinne, de Ruysscher Dirk, Remon Jordi, Berghmans Thierry, Dingemans Anne-Marie C, Besse Benjamin, Hendriks Lizza E L
Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
Department of Cardiothoracic Surgery, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
Lung Cancer. 2025 Jan;199:108061. doi: 10.1016/j.lungcan.2024.108061. Epub 2024 Dec 15.
The EORTC-Lung Cancer Group initiated a Delphi consensus process to establish a consensual definition of resectable stage III non-small cell lung cancer (NSCLC) for the use in clinical trials, including a systematic review, survey, and review of clinical cases. Here, the survey results are presented, aimed to identify areas of controversy.
A survey was distributed among the members of six international organizations related to lung cancer. Respondents were interrogated on the resectability (not limited to the technical resectability) of all stage III NSCLC TNM-subsets (8th edition). Additionally, four N2-subdivisions were used. The threshold for agreement was 75%. Answers with "yes" were considered upfront resectable. "Yes" and "maybe" were grouped together and considered potentially resectable. Answers with "no" were considered unresectable.
558 responses were collected from thoracic surgeons (38%), radiation oncologists (27%), medical oncologists (17%), pulmonologists (14%), and others (4%). Most worked in a specialized center (80%), had >5 years of experience (80%), were European (76%), male (73%), and treated >20 patients with stage III NSCLC annually (77%). Agreement was found in 26 (70%) out of 37 TNM-subsets: 9 (24%) were considered (potentially) resectable, and 17 (46%) unresectable. There was no agreement for 11 (30%) TNM-subsets: smaller tumors with N2-multistation, larger tumors with N2-single station, and invasive T4-tumors with maximum N2-single station involvement.
This international and multidisciplinary survey showed agreement on the resectability for the majority of stage III NSCLC TNM-subsets, but also identified several TNM-subsets for which no agreement was found.
欧洲癌症研究与治疗组织肺癌小组启动了一项德尔菲共识程序，以建立可切除的Ⅲ期非小细胞肺癌（NSCLC）的共识定义，供临床试验使用，包括系统评价、调查和临床病例回顾。在此，展示调查结果，旨在确定存在争议的领域。
向六个与肺癌相关的国际组织的成员分发了一份调查问卷。就所有Ⅲ期NSCLC TNM亚组（第8版）的可切除性（不限于技术上的可切除性）询问了受访者。此外，还使用了四个N2亚组。达成一致的阈值为75%。回答“是”的被视为 upfront 可切除。“是”和“可能”归为一组，被视为潜在可切除。回答“否”的被视为不可切除。
共收集到558份回复，来自胸外科医生（38%）、放射肿瘤学家（27%）、肿瘤内科医生（17%）、肺科医生（14%）和其他人员（4%）。大多数人在专业中心工作（80%），有超过5年的经验（80%），是欧洲人（76%），男性（73%），每年治疗超过20例Ⅲ期NSCLC患者（77%）。在37个TNM亚组中的26个（70%）中达成了一致：9个（24%）被认为（潜在）可切除，17个（46%）不可切除。11个（30%）TNM亚组未达成一致：N2多站的较小肿瘤、N2单站的较大肿瘤以及N2单站受累最多的浸润性T4肿瘤。
这项国际多学科调查显示，对于大多数Ⅲ期NSCLC TNM亚组的可切除性达成了一致，但也确定了几个未达成一致的TNM亚组。
