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Kim JY, Lee HP, Yun JK, Lee GD, Choi S, Kim HR, Kim YH, Kim DK, Park SI. Risk prediction of multiple-station N2 metastasis in patients with upfront surgery for clinical single-station N2 non-small cell lung cancer. Sci Rep 2024; 14:18800. [PMID: 39138302 PMCID: PMC11322601 DOI: 10.1038/s41598-024-69260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/02/2024] [Indexed: 08/15/2024] Open
Abstract
To investigate long-term outcomes and develop a risk model for pathological multi-station N2 (pN2b) in patients who underwent upfront surgery for clinical single-station N2 (cN2a) non-small cell lung cancer (NSCLC). From 2006 to 2018, 547 patients who had upfront surgery for suspected cN2a NSCLC underwent analysis. A risk model for predicting pN2b metastasis was developed using preoperative clinical variables via multivariable logistic analysis. Among 547 clinical cN2a NSCLC patients, 118 (21.6%), 58 (10.6%), and 371 (67.8%) had pN0, pN1, and pN2. Among 371 pN2 NSCLC patients, 77 (20.8%), 165 (44.5%), and 129 (34.7%) had pN2a1, pN2a2, and pN2b. The 5-year overall survival rates for pN2a1 and pN2a2 were significantly higher than for pN2b (p = 0.041). Histologic type (p < 0.001), age ≤ 50 years (p < 0.001), preoperatively confirmed N2 metastasis (p < 0.001), and clinical stage IIIB (vs. IIIA) (p = 0.003) were independent risk factors for pN2b metastasis. The risk scoring system based on this model demonstrated good discriminant ability for pN2b disease (area under receiver operating characteristic: 0.779). In cN2a NSCLC patients, those with multiple N2 metastases indicate worse prognosis than those with a single N2 metastasis. Our risk scoring system effectively predicts pN2b in these patients.
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Affiliation(s)
- Joon Young Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Han Pil Lee
- Department of Thoracic and Cardiovascular Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
- Department of Thoracic and Cardiovascular Surgery, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yong-Hee Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Seung-Il Park
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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Oh NE, Choe J, Yun JK, Ji W, Kim S, Chae EJ, Lee SM, Seo JB. Prognostic Value of Preoperative N Subcategories in Patients with Stage IIIA N2 Non-Small Cell Lung Cancer. Radiol Cardiothorac Imaging 2024; 6:e230347. [PMID: 38990133 PMCID: PMC11369650 DOI: 10.1148/ryct.230347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 04/23/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024]
Abstract
Purpose To evaluate the preoperative risk factors in patients with pathologic IIIA N2 non-small cell lung cancer (NSCLC) who underwent upfront surgery and to evaluate the prognostic value of new N subcategories. Materials and Methods Patients with pathologic stage IIIA N2 NSCLC who underwent upfront surgery in a single tertiary center from January 2015 to April 2021 were retrospectively reviewed. Each patient's clinical N (cN) was assigned to one of six subcategories (cN0, cN1a, cN1b, cN2a1, cN2a2, and cN2b) based on recently proposed N descriptors. Cox regression analysis was used to identify the significant prognostic factors for recurrence-free survival (RFS) and overall survival (OS). Results A total of 366 patients (mean age ± SD, 62.0 years ± 10.1; 202 male patients [55%]) were analyzed. The recurrence rate was 55% (203 of 366 patients) over a median follow-up of 37.3 months. Multivariable analysis demonstrated that cN (hazard ratios [HRs] for cN1 and cN2b compared with cN0, 1.66 [95% CI: 1.11, 2.48] and 2.11 [95% CI: 1.32, 3.38], respectively) and maximum lymph node (LN) size at N1 station (≥12 mm; HR, 1.62 [95% CI: 1.15, 2.29]), in addition to clinical T category (HR, 1.51 [95% CI: 1.14, 1.99]), were independent prognostic factors for RFS. For OS, clinical N subcategories (cN1, cN2a2, and cN2b vs cN0; HRs, 1.91 [95% CI: 1.11, 3.27], 1.89 [95% CI: 1.13, 2.18], and 2.02 [95% CI: 1.07, 3.80], respectively) and LN size at N1 station (HR, 1.75 [95% CI: 1.12, 2.71]) were independent prognostic factors. For clinical N1, OS was further stratified according to LN size (log-rank test, P < .001). Conclusion Assessing the proposed N subcategories by reporting single versus multistation involvement of N2 disease and maximum size of metastatic LN, reflecting metastatic burden, at preoperative CT may offer useful prognostic information for planning optimal treatment strategies. Keywords: CT, Lung, Staging, Non-Small Cell Lung Cancer Supplemental material is available for this article. ©RSNA, 2024.
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Affiliation(s)
- Na Eun Oh
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
| | - Jooae Choe
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
| | - Jae Kwang Yun
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
| | - Wonjun Ji
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
| | - Seonok Kim
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
| | - Eun Jin Chae
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
| | - Sang Min Lee
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
| | - Joon Beom Seo
- From the Department of Radiology and Research Institute of Radiology
(N.E.O., J.C., E.J.C., S.M.L., J.B.S.), Department of Thoracic and
Cardiovascular Surgery (J.K.Y.), Department of Internal Medicine, Division of
Pulmonology and Critical Care Medicine (W.J.), and Department of Clinical
Epidemiology and Biostatistics (S.K.), University of Ulsan College of Medicine,
Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736,
Korea
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