Demirdöğen Ezgi, Terzi Orkun Eray, Aydın Güçlü Özge, Ursavaş Ahmet, Karadağ Mehmet
Department of Pulmonology, Faculty of Medicine, Bursa Uludağ University, Bursa 16059, Türkiye.
Department of Pulmonology, University of Health Sciences Bursa Yüksek İhtisas Training and Research Hospital, Bursa 16310, Türkiye.
Diagnostics (Basel). 2025 Jun 20;15(13):1570. doi: 10.3390/diagnostics15131570.
The distinction between N2a and N2b in the lung cancer TNM 9th edition staging system has reduced the heterogeneity of prognosis using the previous staging system. Moreover, this distinction may enable new treatment approaches in non-small-cell lung cancer (NSCLC). We aimed to evaluate the differences in survival between 8th- and 9th-edition staging and the mortality prediction of the TNM 9th edition in NSCLC patients who did not undergo surgical staging and who were "N"-staged with solely endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) without endoscopic ultrasonography (EUS). Lung cancer patients who were newly diagnosed and staged with EBUS between May 2016 and January 2023 were retrospectively reviewed. Patients were divided into two groups, "All M0 = Model 1" and "T1-2 N1-2-3 M0 = Model 2", and compared according to their survival for both the 8th and 9th edition TNM staging systems. Cox regression analyses were performed for independent predictors of 2-year mortality. In this retrospective study, a total of 90 patients were included. Most of the patients were male (84.4%), and the mean age of the study group was 64.0 ± 9.6; deceased patients were older ( = 0.024). There were no differences between groups in terms of smoking habit, comorbidities, tumor PET/CT localization, or 8th and 9th N-staging results with EBUS. The median follow-up period was 26 (0-100) months and longer for living patients than deceased patients in both groups (42 (23-100) vs. 18 (0-74), = 0.03; 36 (24-100) vs. 20 (1-74), < 0.001). According to the 8th edition of TNM staging, N2 stage (HR 2.26, 95% CI 1.01-5.05, = 0.045) and N3 disease (HR 3.31, 95% CI 1.43-7.67, = 0.005) are independent predictors of two-year mortality for Model 1 patients. When patients were staged according to the 9th edition TNM with EBUS, the relationship between N2a and mortality was not significant, while N2B disease increased the 2-year mortality risk by 2.78-fold (95% 1.07-7.22, = 0.035), and N3 disease increased it by 3.31-fold (95% 1.43-7.67, = 0.005). According to the TNM 9th edition staging system, we demonstrated that N2b disease significantly increases the risk of mortality in NSCLC cases using systematic mediastinal staging with EBUS-TBNA alone.
肺癌TNM第9版分期系统中N2a和N2b的区分降低了使用先前分期系统时预后的异质性。此外，这种区分可能会为非小细胞肺癌（NSCLC）带来新的治疗方法。我们旨在评估第8版和第9版分期之间的生存差异，以及在未接受手术分期且仅通过支气管内超声引导下经支气管针吸活检（EBUS-TBNA）而非内镜超声检查（EUS）进行“N”分期的NSCLC患者中TNM第9版的死亡率预测。回顾性分析了2016年5月至2023年1月期间新诊断并通过EBUS进行分期的肺癌患者。患者分为两组，“所有M0 = 模型1”和“T1-2 N1-2-3 M0 = 模型2”，并根据第8版和第9版TNM分期系统的生存情况进行比较。对2年死亡率的独立预测因素进行Cox回归分析。在这项回顾性研究中，共纳入90例患者。大多数患者为男性（84.4%），研究组的平均年龄为64.0±9.6岁；死亡患者年龄更大（P = 0.024）。两组在吸烟习惯、合并症、肿瘤PET/CT定位或EBUS的第8版和第9版N分期结果方面无差异。中位随访期为26（0-100）个月，两组中存活患者的随访期均长于死亡患者（42（23-100）对18（0-74），P = 0.03；36（24-100）对20（1-74），P < 0.001）。根据第8版TNM分期，对于模型1患者，N2期（HR 2.26，95%CI 1.01-5.05，P = 0.045）和N3期疾病（HR 3.31，95%CI 1.43-7.67，P = 0.005）是2年死亡率的独立预测因素。当患者根据第9版TNM通过EBUS进行分期时，N2a与死亡率之间的关系不显著，而N2B疾病使2年死亡风险增加2.78倍（95% 1.07-7.22，P = 0.035），N3疾病使其增加3.31倍（95% 1.43-7.67，P = 0.005）。根据TNM第9版分期系统，我们证明仅使用EBUS-TBNA进行系统性纵隔分期时，N2b疾病会显著增加NSCLC病例的死亡风险。
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