Wu Tong, Cai Jingsheng, Li Yun, Xie Rongjing, Chen Kezhong
Thoracic Oncology Institute&Research Unit of Intelligence Diagnosis and Treatment in Early Non-small Cell Lung Cancer, Chinese Academy of Medical Sciences, 2021RU002, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing, 100044, P.R. China.
Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, P.R. China.
BMC Cancer. 2025 Mar 12;25(1):446. doi: 10.1186/s12885-024-13364-6.
The 9th edition of the lung cancer tumor-node-metastasis (TNM) staging system downgrades certain non-small cell lung cancer (NSCLC) patients from stage IIIA (T1N2) to IIB(T1N2a). This study aimed to externally validate this stage adjustment.
Consecutive resected stage IIB and IIIA (the 9th edition of lung cancer TNM staging manual) NSCLC patients were included. Stage IIB was divided into groups A, B, and C according to lymph node involvement. Group A, patients who having single-station N2 without N1 involvement; Group B, patients who having single-station N2 with N1 involvements; Group C, patients who having station N1 involvement or N0. The stage IIIA patients divided into Group D. Overall survival (OS) and disease-free survival (DFS) were compared using the Kaplan-Meier method, with propensity score matching (PSM) employed to mitigate potential biases. COX regression models were utilized to assess prognostic differences.
224 stage IIB and 227 stage IIIA cases was included. There were 38, 66 and 120 patients in the Group A, B and C, respectively. Univariate COX analysis indicated comparable prognoses between the Group A and Group C patients, whereas Group B patients exhibited poorer outcomes. Upon combining the Group A and Group C patients, multivariate COX analysis demonstrated a significantly worse prognosis for Group B patients compared to those with Group A + C patients (OS, P = 0.035; DFS, P = 0.021). Further comparisons between Group B and Group D patients, following PSM analysis, indicated similar survivals (OS: P = 0.390; DFS: P = 0.210).
In the 9th edition of the lung cancer TNM staging system, the prognosis of stage IIB N2a2 patients was worse than that of remaining stage IIB patients but comparable to that of stage IIIA patients. We proposed that stage IIB N2a2 patients should be maintained as stage IIIA.
肺癌肿瘤-淋巴结-转移（TNM）分期系统第9版将某些非小细胞肺癌（NSCLC）患者从ⅢA期（T1N2）降为ⅡB期（T1N2a）。本研究旨在对这一分期调整进行外部验证。
纳入连续接受手术切除的ⅡB期和ⅢA期（根据肺癌TNM分期手册第9版）NSCLC患者。ⅡB期根据淋巴结受累情况分为A、B、C组。A组，无N1受累的单站N2患者；B组，有N1受累的单站N2患者；C组，有N1受累或N0的患者。ⅢA期患者分为D组。采用Kaplan-Meier法比较总生存期（OS）和无病生存期（DFS），并采用倾向评分匹配（PSM）来减轻潜在偏倚。利用COX回归模型评估预后差异。
纳入224例ⅡB期和227例ⅢA期病例。A、B、C组分别有38、66和120例患者。单因素COX分析表明，A组和C组患者的预后相当，而B组患者的预后较差。将A组和C组合并后，多因素COX分析表明，与A+C组患者相比，B组患者的预后明显更差（OS，P = 0.035；DFS，P = 0.021）。PSM分析后，B组和D组患者的进一步比较表明，生存期相似（OS：P = 0.390；DFS：P = 0.210）。
在肺癌TNM分期系统第9版中，ⅡB期N2a2患者的预后比其余ⅡB期患者差，但与ⅢA期患者相当。我们建议将ⅡB期N2a2患者维持为ⅢA期。
