Abstract
The eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer was introduced in 2017 and included major revisions, especially of stage III. For the subgroup stage IIIA-N2 non-small-cell lung cancer (NSCLC), surgical resection remains controversial due to heterogeneous disease entity. The aim of this study was to evaluate the clinicopathologic features and prognostic factors of patients with completely resected stage IIIA-N2 NSCLC. We retrospectively evaluated 77 consecutive patients with pathologic stage IIIA-N2 NSCLC (AJCC eighth edition) who underwent surgical resection with curative intent in China Medical University Hospital between 2006 and 2014. Survival analysis was conducted, using the Kaplan–Meier method. Prognostic factors predicting overall survival (OS) and disease-free survival (DFS) were analyzed, using log-rank tests and multivariate Cox proportional hazards models. Of the 77 patients with pathologic stage IIIA-N2 NSCLC examined, 35 (45.5%) were diagnosed before surgery and 42 (54.5%) were diagnosed unexpectedly during surgery. The mean age of patients was 59 years, and the mean length of follow-up was 38.1 months. The overall one-, three-, and five-year OS rates were 91.9%, 61.3%, and 33.5%, respectively. Multivariate analysis showed that tumor size <3 cm (hazards ratio (HR): 0.373, p = 0.003) and video-assisted thoracoscopic surgery (VATS) approach (HR: 0.383, p = 0.014) were significant predictors for improved OS. For patients with surgically treated, pathologic stage IIIA-N2 NSCLC, tumor size <3 cm and the VATS approach seemed to be associated with better prognosis.
Highlights
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the world
Based on a global database of lung-cancer cases assembled by the International Association for the Study of Lung Cancer (IASLC) [5], the eighth edition of the American Joint Committee on Cancer (AJCC) staging system for lung cancer was published in 2017 [6], and it was implemented in clinical practice worldwide in 2018 [7]
Thirty-five (45.5%) patients were diagnosed as N2 disease before surgery, and 42 (54.5%) were diagnosed unexpectedly during surgery
Summary
Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death in the world. In 2018, an estimated 2.1 million new cases (1,368,524 in men and 725,352 in women) of lung and bronchial cancer were diagnosed, and 1.8 million individuals (1,184,947 in men and 576,060 in women) were expected to die of the tumor [1]. Despite recent advances in molecularly targeted therapy and immunotherapy, the long-term survival of patients with lung cancer remains poor, and the five-year-survival rate is below 20% [2,3]. For patients with former stage IIIA-N2 disease, the reclassification of tumor size more than 5 cm shifting from T2b to T3 (> 5 cm but < 7 cm) and from T3 to T4 (> 7 cm) results in a change of stage from IIIA to IIIB
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