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. 2025 Sep 30;17(9):6451-6460.
doi: 10.21037/jtd-2024-2039. Epub 2025 Sep 26.

Survival of patients with node-negative lung cancer and chest wall invasion

Anupama Singh  1 , Ashley L Deeb  1 , Camille Mathey-Andrews  2 , Miles McAllister  1 , Alexandra L Potter  2 , Emanuele Mazzola  3 , Yue Xie  3 , Chi-Fu Jeffrey Yang  2 , Paula Ugalde Figueroa  1
Affiliations

Survival of patients with node-negative lung cancer and chest wall invasion

Anupama Singh et al. J Thorac Dis. .

Abstract

Background: Patients with T3 non-small cell lung cancer (NSCLC) with chest wall invasion (CWI) have poorer survival than patients with T3 NSCLC defined by other T3 descriptors, but their survival has not been compared with patients with T4 NSCLC. Our objective was to compare the survival of patients with NSCLC with CWI, currently a T3 descriptor, with that of patients with T4 NSCLC.

Methods: A retrospective analysis was conducted of the National Cancer Database (NCDB) comparing patients diagnosed with node-negative NSCLC <7 cm with CWI to those diagnosed with cT4N0M0 NSCLC from 2010-2015. A 1:1 propensity match was performed. Demographics, comorbidities, and tumor characteristics were compared utilizing chi-squared and Wilcoxon rank-sum tests. Kaplan-Meier analysis was used to estimate 5-year overall survival (OS).

Results: In total, 1,734 matched patients were studied (867 T3 with CWI, 867 T4). There were no significant differences in baseline demographics, tumor characteristics, treatment, or surgical approach used (all P>0.05). There were no significant differences in 30-day (P=0.27) or 90-day (P=0.33) mortality between the two groups. Five-year OS was also similar between the two groups [44.0% T3 with CWI, 95% confidence interval (CI): 41-47% vs. 43.8% T4, 95% CI: 40-47%; P=0.50]. Median survival was 40 months (range 0.2-123 months for the T3 cohort and 0.3-120 months for the T4 cohort).

Conclusions: CWI might serve better as a T4 descriptor in future iterations of the Tumor, Node, Metastasis (TNM) classifications. This would allow providers to better stage and treat patients, which would subsequently affect survival.

Keywords: Non-small cell lung cancer (NSCLC); neoplasm invasiveness; neoplasm staging; prognosis; thoracic wall.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-2024-2039/coif). A.S. and A.L.D. state that their salaries were funded by the John D. Mitchell Thoracic Oncology Fellowship. C.F.J.Y. is on the advisory board for AstraZeneca and Genentech and also reports an honorarium from AstraZeneca. P.U.F. is on the advisory board for AstraZeneca and Medtronic and also reports honoraria from AstraZeneca, Medtronic, Johnson & Johnson and Roche. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of cohort selection. CWI, chest wall invasion; NSCLC, non-small cell lung cancer.
Figure 2
Figure 2
Kaplan-Meier 5-year OS estimates of patients with T3 and chest wall invasion vs. patients with T4 disease. There were no differences in 5-year OS between the two groups. CI, confidence interval; OS, overall survival.
See this image and copyright information in PMC

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