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Exploring the Potential Different Outcomes Associated With the Different Phenotypes Under the Shared Pathologic T3N0
Terrance Peng1, Sean C Wightman1, Li Ding2
1Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California.
JTO Clinical and Research Reports
|September 30, 2021
Summary
Patients with pT3N0 non-small cell lung cancer (NSCLC) have better survival than pT1-2N1 NSCLC. However, multiple T3 descriptors and chest wall involvement in pT3N0 NSCLC indicate worse outcomes.
Area of Science:
- Oncology
- Thoracic Surgery
- Cancer Research
Background:
- Non-small cell lung cancer (NSCLC) staging is crucial for treatment planning and prognosis.
- Understanding survival differences between NSCLC substages informs clinical decision-making.
- Pathologic T descriptors significantly impact patient outcomes.
Purpose of the Study:
- To compare overall survival (OS) between patients with pT1-2N1 and pT3N0 NSCLC.
- To analyze OS within various subtypes of pT3N0 NSCLC.
- To identify prognostic factors influencing survival in stage IIB NSCLC.
Main Methods:
- Utilized the National Cancer Database to identify treatment-naive patients with stage IIB NSCLC.
- Included patients with pT3N0 or pT1-2N1 NSCLC who underwent definitive surgery.
- Subdivided pT3N0 cohort by T3 descriptor multiplicity and subtype; compared 5-year OS using Kaplan-Meier and Cox models.
Main Results:
- pT3N0 NSCLC demonstrated significantly greater 5-year OS than pT1-2N1 NSCLC (52.4% vs. 47.8%).
- Among patients receiving chemotherapy, multiple-T3 descriptors in pT3N0 NSCLC correlated with lower 5-year OS (49.0%) compared to single-T3 (63.3%).
- Chest wall-only pT3N0 NSCLC had the lowest 5-year OS (52.2%) among single-T3 subtypes. Adjuvant chemotherapy reduced the risk of death in pT3N0 cohort (HR=0.65).
Conclusions:
- pT3N0 NSCLC offers superior 5-year OS post-surgery compared to pT1-2N1 NSCLC.
- Multiple T3 descriptors and chest wall invasion in pT3N0 NSCLC are linked to poorer survival.
- Future NSCLC staging systems should incorporate distinctions for multiple T3 descriptors in pT3N0 disease.
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