Prognostic Differences Among T3 Descriptor Subgroups in Resected Lung Cancer

Prognostic heterogeneity may exist among T3 nonsmall cell lung cancers depending on specific T3 descriptors. Our study aimed to evaluate the survival differences among T3 subgroups in patients with resected lung cancer.

This retrospective cohort study included 381 patients with pathologically confirmed (p)T3N0/1 nonsmall cell lung cancer. Patients with mediastinal lymph node metastases or superior sulcus tumors were excluded. Patients were classified into three subgroups; the T3-ordinary group (only tumor diameter >5 cm but ≤7 cm, or only an additional tumor nodule in the same lobe as the primary tumor, n = 246), the T3-invasion group (the primary tumor directly invades any of the structures; only the phernic nerve, pericardium, parietal pleura or the chest wall, n = 57), and the T3-multiple group (the tumor had at least two T3 descriptors, n = 78).

The 5-year overall survival rate was 52% (median survival time: 63 months; 95% CI: 53-72 months). A significant difference was observed between the three groups in terms of median survival time (T3-ordinary, 70 months; T3-invasion, 58 months; T3-multiple, 43 months; chi-square = 5.86, p = 0.04-log rank). Moreover, the 5-year survival rate was significantly higher in the T3 single group than in the T3 multiple group (54.5% vs. 40.4%, p = 0.03). Multivariate analysis showed that lymph node status (p = 0.007), adjuvant treatment (p < 0.001), major surgical complications (p < 0.001), and T3-subgroups (p = 0.02) were independent prognostic factors.

Patients with two or more pT3 descriptors or tumors exhibiting invasion have the worst survival rates. Stage migration can be discussed in these patients.