Recurrence Risk Stratification by Station- and Zone-Based Nodal Classification in Resected Non-Small Cell Lung Cancer
Atsushi Kamigaichi1, Takahiro Mimae1, Norifumi Tsubokawa1
1Department of Surgical Oncology, Hiroshima University, Hiroshima 734-8551, Japan.
Summary
Classifying non-small cell lung cancer (NSCLC) by lymph node zones and stations improves prediction of recurrence risk. This zone- and station-based approach offers a refined N staging for better patient stratification.
Area of Science:
- Oncology
- Thoracic Surgery
- Cancer Staging
Background:
- The ninth edition of the tumour-node-metastasis (TNM) classification for N staging in non-small cell lung cancer (NSCLC) has limitations.
- Accurate prediction of postoperative recurrence risk is crucial for optimizing treatment strategies in NSCLC patients.
Purpose of the Study:
- To evaluate the efficacy of classifying N stage based on lymph node zones and the number of involved stations.
- To determine if this refined classification better predicts postoperative recurrence risk in NSCLC compared to existing TNM staging.
Main Methods:
- Inclusion of 671 patients with pathological N1 or N2, M0 NSCLC.
- Categorization of lymph node zones (peripheral, hilar, mediastinal, aortopulmonary, subcarinal) and subdivision of N categories (N1a, N1b, N2a1, N2a2, N2b) based on location and number of involved stations.
- Analysis of recurrence-free survival (RFS) and cumulative incidence of recurrence (CIR) using both station- and zone-based classifications.
Main Results:
- Both station- and zone-based classifications effectively stratified RFS and CIR (P < .001 for both).
- Station- and zone-based N2a1 showed RFS comparable to N1b.
- Zone-based N2a2 and N2b demonstrated a trend towards worse RFS compared to zone-based N2a1.
Conclusions:
- Both station- and zone-based nodal classifications are effective in stratifying recurrence risk in NSCLC.
- These refined classifications are promising for further N category stratification in NSCLC staging.
