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Chen CY, Wu BR, Chen CH, Cheng WC, Chen WC, Liao WC, Chen CY, Hsia TC, Tu CY. Prognostic Value of Tumor Size in Resected Stage IIIA-N2 Non-Small-Cell Lung Cancer. J Clin Med 2020; 9:jcm9051307. [PMID: 32370082 PMCID: PMC7290400 DOI: 10.3390/jcm9051307] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/25/2022] Open
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.
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Affiliation(s)
- Chih-Yu Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Bing-Ru Wu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Chia-Hung Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Wen-Chien Cheng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
| | - Wei-Chun Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- Department of Respiratory Therapy, China Medical University, Taichung 40402, Taiwan
- Hyperbaric oxygen therapy center, China Medical University Hospital, Taichung 40447, Taiwan
| | - Wei-Chih Liao
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
- Hyperbaric oxygen therapy center, China Medical University Hospital, Taichung 40447, Taiwan
- Correspondence: ; Tel.: +886-4-2205-2121 (ext. 4661)
| | - Chih-Yi Chen
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Te-Chun Hsia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- Department of Respiratory Therapy, China Medical University, Taichung 40402, Taiwan
- Hyperbaric oxygen therapy center, China Medical University Hospital, Taichung 40447, Taiwan
| | - Chih-Yen Tu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung 40447, Taiwan; (C.-Y.C.); (B.-R.W.); (C.-H.C.); (W.-C.C.); (W.-C.C.); (T.-C.H.); (C.-Y.T.)
- School of Medicine, China Medical University, Taichung 40402, Taiwan
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Zheng D, Ye T, Hu H, Zhang Y, Sun Y, Xiang J, Chen H. Upfront surgery as first-line therapy in selected patients with stage IIIA non-small cell lung cancer. J Thorac Cardiovasc Surg 2017; 155:1814-1822.e4. [PMID: 29221745 DOI: 10.1016/j.jtcvs.2017.10.075] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 09/23/2017] [Accepted: 10/13/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Surgery plays an important role in the multidisciplinary treatment strategy for patients with stage IIIA non-small cell lung cancer (NSCLC). Besides induction therapy, patients could benefit from surgery followed by adjuvant chemotherapy and radiotherapy. This study analyzed a subset of patients with pIIIA NSCLC who underwent upfront surgery as first-line therapy. METHODS Selected patients with pIIIA NSCLC who received upfront surgery were retrospectively analyzed. Clinicopathologic characteristics and survival outcomes including progression-free survival (PFS) and overall survival (OS) were evaluated. RESULTS A total of 668 patients were identified. Five hundred sixty-five patients received adjuvant chemotherapy, and 157 patients received adjuvant radiotherapy after surgery. The median PFS and OS were 17.0 and 44.0 months, respectively. The 3-year and 5-year PFS rates were 31.6% and 21.0%, and the 3-year and 5-year OS rates were 54.7% and 43.0%. Patients with adenocarcinoma (AD) had better OS than those with squamous cell carcinoma (5-year OS: P = .026). Patients with low-grade AD (acinar and papillar) had a similar PFS and OS compared with patients with high-grade AD (solid, micropapillary, and mucinous) (5-year PFS: P = .894; 5-year OS: P = .439). Patients with mutated epidermal growth factor receptor had a similar OS to patients with wild-type epidermal growth factor receptor (5-year OS: P = .121). Patients with clinical N0 status (P = .004) and patients with single-station of pathologic N2 (P < .001) had better OS. CONCLUSIONS Upfront surgery followed by adjuvant therapy may provide favorable survival outcomes for selected patients with pIIIA NSCLC, especially for patients with AD or patients with clinical N0 and pathologic single-station N2 diseases.
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Affiliation(s)
- Difan Zheng
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Ting Ye
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Hong Hu
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Yawei Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Yihua Sun
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Jiaqing Xiang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Fudan University Shanghai Medical College, Shanghai, China.
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Moon Y, Kim KS, Lee KY, Sung SW, Kim YK, Park JK. Clinicopathologic Factors Associated With Occult Lymph Node Metastasis in Patients With Clinically Diagnosed N0 Lung Adenocarcinoma. Ann Thorac Surg 2016; 101:1928-35. [PMID: 26952299 DOI: 10.1016/j.athoracsur.2015.11.056] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/15/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND In some patients, clinical N0 (cN0) lung adenocarcinoma diagnosed by preoperative computed tomography scanning and positron emission tomography scanning was staged as pathologic N1 (pN1) or N2 (pN2) postoperatively. The aim of this study was to determine the preoperative and postoperative clinicopathologic factors related to nodal upstaging after a surgical operation. METHODS We conducted a retrospective chart review of 350 patients treated for cN0 lung adenocarcinoma by curative resection. We analyzed clinicopathologic findings, comparing pN0 patients with the nodal upstaging group. RESULTS Of 350 patients treated for cN0 tumors, 305 (87.1%) were confirmed postoperatively as having pN0 tumors, and 45 (12.9%) were confirmed as having pN1 or pN2 tumors. The mean maximum standardized uptake value (SUVmax) was higher in the nodal upstaging group than in the pN0 group (6.9 versus 3.8, p = 0.004); the upstaging group also included more cases in which SUVmax was greater than 5 (70.5% versus 24.8%, p < 0.001). Pleural invasion, lymphatic invasion, and vascular invasion were all more frequently seen in the nodal upstaging group than in the pN0 group (all p < 0.001). The presence of tumors with a micropapillary component was higher in the nodal upstaging group (p < 0.001). Multivariate logistic regression analysis identified SUVmax greater than 5, lymphatic invasion, vascular invasion, and a micropapillary component as significant risk factors for nodal upstaging. CONCLUSIONS In lung adenocarcinoma diagnosed as clinical N0 by chest computed tomography and positron emission tomography scanning, the possibility of occult lymph node metastasis increases with SUVmax greater than 5 and when lymphatic invasion, vascular invasion, and a micropapillary component are present.
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Affiliation(s)
- Youngkyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Kyung Soo Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Kyo Young Lee
- Department of Hospital Pathology, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Sook Whan Sung
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Young Kyoon Kim
- Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, Catholic University of Korea, Seoul, Korea.
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Moon Y, Lee KY, Kim KS, Park JK. Clinicopathologic correlates of postoperative N1 or N2 nodal upstaging in non-small cell lung cancer. J Thorac Dis 2016; 8:79-85. [PMID: 26904215 DOI: 10.3978/j.issn.2072-1439.2016.01.08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical and pathologic determinations of lymph node staging are critical in the treatment of lung cancer. However, up- or downstaging of nodal status frequently is necessitated by postsurgical findings. This study was conducted to evaluate clinicopathologic features that impact nodal upstaging in patients staged primarily via positron emission tomography/computed tomography (PET/CT) and chest CT prior to surgery. METHODS Between years 2011 and 2014, 634 patients underwent surgical treatment for non-small cell lung cancer (NSCLC) at our institution. Excluding 37 patients (given induction chemotherapy), 103 patients pathologically staged as N1 or N2 NSCLC. Nodal upstaging patients were classified into group A and non-upstaging patients into group B. We compared clinical characteristics and pathological results of group A with group B. RESULTS Ultimately, 59 patients (57.3%) were assigned to group A and 44 patients (42.7%) to group B. Patients in group A (vs. group B) were significantly younger (61.6 vs. 68.4 years; P<0.001) and more often were female (47.5% vs. 15.9%; P=0.001), with shorter smoking histories (12.2 vs. 28.8 pack years; P<0.001) and lower maximum standardized uptake values (SUVmax) (7.3 vs. 10.4; P=0.001). Most upstaged (group A) tumors (50/59, 84.7%) were adenocarcinomas, displaying micropapillary (MPC; n=36) and lepidic (n=35) component positivity with significantly greater frequency (both, P<0.001); and the frequency of epidermal growth factor receptor (EGFR) mutation (n=36) was significantly greater in this subset (P=0.001). Multivariate analysis (logistic regression) indicated a significant correlation between MPC positivity and nodal upstaging (P=0.013). CONCLUSIONS In patients upstaged postoperatively to N1 or N2 stage of NSCLC, occult lymph node metastasis and MPC positivity were significantly related.
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Affiliation(s)
- Youngkyu Moon
- 1 Department of Thoracic & Cardiovascular Surgery, 2 Department of Hospital Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyo Young Lee
- 1 Department of Thoracic & Cardiovascular Surgery, 2 Department of Hospital Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Soo Kim
- 1 Department of Thoracic & Cardiovascular Surgery, 2 Department of Hospital Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Kil Park
- 1 Department of Thoracic & Cardiovascular Surgery, 2 Department of Hospital Pathology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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