Abstract
Simple SummaryLung cancer patients have different survival outcomes depending on tumor size and growth pattern after surgery. This study aims to optimize tumor classification, and identify patients who could benefit the most from additional chemotherapy after surgery. In a specific lung cancer cohort, we study how a new redefinition of tumor classification could lead to a more solid recommendation of which patients to offer chemotherapy after surgery.The current pT3N0 category represents a heterogeneous subgroup involving tumor size, separate tumor nodes in one lobe, and locoregional growth pattern. We aim to validate outcomes according to the eighth edition of the TNM staging classification. A total of 281 patients who had undergone curative lung cancer surgery staged with TNM-7 in two German centers were retrospectively analyzed. The subtypes tumor size >7 cm and multiple nodules were grouped as T3a, and the subtypes parietal pleura invasion and mixed were grouped as T3b. We stratified survival by subtype and investigated the relative benefit of adjuvant chemotherapy according to subtype. The 5-year overall survival (OS) rates differed between the different subtypes tumor diameter >7 cm (71.5%), multiple nodules in one lobe (71.0%) (grouped as T3a), parietal pleura invasion (59.%), and mixed subtype (5-year OS 50.3%) (grouped as T3b), respectively. The cohort as a whole did not gain significant OS benefit from adjuvant chemotherapy. In contrast, adjuvant chemotherapy significantly improved OS in the T3b subgroup (logrank p = 0.03). This multicenter cohort analysis of pT3N0 patients identifies a new prognostic mixed subtype. Tumors >7 cm should not be moved to pT4. Patients with T3b tumors have significantly worse survival than patients with T3a tumors.
Highlights
TNM classification changes from the seventh edition (TNM-7) to the eighth edition (TNM-8) are based on current analyses of the International Association for the Study ofLung Cancer (IASLC) database [1]
The aim of this study is to present up-to-date outcomes in surgically resected patients with pT3N0 tumors according to TNM-7 to validate the current T3 descriptors and evaluate the impact of adjuvant chemotherapy on overall survival
This is a retrospective analysis of patients treated in two tertiary high-volume centers in Germany (Heidelberg and Berlin), who were surgically resected and staged as pT3N0 lung cancer according to the TNM-7 staging classification
Summary
TNM classification changes from the seventh edition (TNM-7) to the eighth edition (TNM-8) are based on current analyses of the International Association for the Study of. Lung Cancer (IASLC) database [1]. The T3 category for lung cancer represents a heterogeneous group based on tumor size, separate tumor nodes in one lobe, and locoregional spread. In TNM-6, tumors with a diameter larger than 3 cm were classified as T2, and satellite tumor nodules within the same lobe as the primary-tumor were classified as T4; separate metastatic tumor nodule(s) in the ipsilateral non-primary lobe(s) of the lung were classified as M1 [3]. In TNM-7, tumor size 5–7 cm was designated as T2b, and tumors >7 cm, or with separate nodules in the same lobe, were categorized as
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