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. 2021 May 18;2(6):100186.
doi: 10.1016/j.jtocrr.2021.100186. eCollection 2021 Jun.

Exploring the Potential Different Outcomes Associated With the Different Phenotypes Under the Shared Pathologic T3N0 Designation

Terrance Peng  1 , Sean C Wightman  1 , Li Ding  2 , Scott M Atay  1 , Evan T Alicuben  3 , Elizabeth A David  1 , Anthony W Kim  1
Affiliations

Exploring the Potential Different Outcomes Associated With the Different Phenotypes Under the Shared Pathologic T3N0 Designation

Terrance Peng et al. JTO Clin Res Rep. .

Abstract

Introduction: The objective of this study was to compare overall survival (OS) between patients with pT1-2N1 versus pT3N0 NSCLC and various subtypes of pT3N0 NSCLC.

Methods: The National Cancer Database was queried to identify treatment-naive patients with pathologic stage IIB primary NSCLC. Patients were included if they were diagnosed with pT3N0 or pT1-2N1 NSCLC and received definitive surgery within 4 months of diagnosis. The pT3N0 cohort was subdivided by single versus multiple concurrent T3 descriptors and single-T3 subtypes. The 5-year OS was compared using the Kaplan-Meier method, and the Cox proportional-hazards model was used to identify prognostic factors for death.

Results: A total of 16,770 patients were included (pT3N0: 7179; pT1-2N1: 9591). pT3N0 NSCLC was associated with greater 5-year OS than pT1-2N1 NSCLC (52.4% versus 47.8%, p < 0.0001). Among patients receiving adjuvant chemotherapy after surgery, multiple-T3 pT3N0 NSCLC was associated with lower 5-year OS than single-T3 pT3N0 NSCLC (49.0% versus 63.3%, p < 0.0001), and chest wall-only pT3N0 NSCLC was associated with the lowest 5-year OS across single-T3 subtypes (additional nodule: 68.3%; size: 64.5%; chest wall: 52.2%, p < 0.0001). Adjuvant chemotherapy was associated with decreased risk of death in the pT3N0 cohort (hazard ratio = 0.65, confidence interval: 0.59-0.71, p < 0.0001).

Conclusions: Patients with pT3N0 NSCLC experience greater 5-year OS after surgery compared with those with pT1-2N1 NSCLC. Multiple-T3 and chest wall-only pT3N0 NSCLC are associated with worse 5-year OS and increased risk of death relative to other T3 subtypes. Future staging systems should consider including notation distinguishing multiple T3 descriptors in pT3N0 NSCLC.

Keywords: Classification; Lung cancer; Staging; T3.

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Figures

Figure 1
Figure 1
Cohort selection diagram.
Figure 2
Figure 2
The 5-year overall survival between pT3N0 and pT1-2N1 NSCLC cohorts. A includes all patients; B includes only patients who received adjuvant chemotherapy; and C includes only patients who did not receive adjuvant chemotherapy.
Figure 3
Figure 3
The 5-year overall survival between single- versus multiple-T3 pT3N0 NSCLC cohorts. It includes only patients who received adjuvant chemotherapy.
Figure 4
Figure 4
The 5-year overall survival across single-T3 pT3N0 NSCLC subgroups. It includes only patients who received adjuvant chemotherapy. In accordance with the data use agreement, the peri-phrenic cohort was excluded from this figure owing to small sample size (n < 10). Additional analyses were performed, revealing significant survival differences between each pair of subgroups (Supplementary Data 3).
Figure 5
Figure 5
The 5-year overall survival between pairs of single-T3 pT3N0 NSCLC subgroups. It includes only patients who received adjuvant chemotherapy. A includes the chest wall-only and additional nodule-only subgroups; B includes the chest wall-only and tumor size-only subgroups; and C includes the additional nodule-only and tumor size-only subgroups. In accordance with the data use agreement, the peri-phrenic cohort was excluded from this figure owing to small sample size (n < 10).
See this image and copyright information in PMC

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