Zentralbl Chir 2019; 144(S 01): S59
DOI: 10.1055/s-0039-1694105
Vorträge – DACH-Jahrestagung: nummerisch aufsteigend sortiert
Georg Thieme Verlag KG Stuttgart · New York

Stage IIIaA should be divided in two different subgroups according to T and N status in patients with resected lung cancer: validation with another center database

N Citak
1   University of Zürich Thoracic Surgery Department, Zürich, Switzerland
,
L Guglielmetti
1   University of Zürich Thoracic Surgery Department, Zürich, Switzerland
,
Y Aksoy
2   Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, Istanbul, Turkey
,
O Isgörücü
3   Bakirköy Sadi Konuk Research and Education Hospital, Istanbul, Turkey
,
M Metin
2   Yedikule Thoracic Surgery and Chest Disease Research and Education Hospital, Istanbul, Turkey
,
A Sayar
3   Bakirköy Sadi Konuk Research and Education Hospital, Istanbul, Turkey
,
I Opitz
1   University of Zürich Thoracic Surgery Department, Zürich, Switzerland
,
D Schneiter
1   University of Zürich Thoracic Surgery Department, Zürich, Switzerland
,
W Weder
1   University of Zürich Thoracic Surgery Department, Zürich, Switzerland
,
I Inci
1   University of Zürich Thoracic Surgery Department, Zürich, Switzerland
› Author Affiliations
Further Information

Publication History

Publication Date:
04 September 2019 (online)

Also available at
 

Background:

Stage IIIA-NSCLC includes a very heterogeneous group of patients depending on tumor localization, and extension of nodal disease. Therefore therapy still remains very controversial. The purpose of our study was to compare the survival between Stage IIIA-subsets (T3N1-T4N0/1 versus T1/2N2), and to validate our results with another center database.

Material and method:

Between 2007 and 2017, completely resected patients with Stage IIIA/B-NSCLC were retrospectively analyzed. There were 424 patients had Stage IIIA and 82 patients had Stage IIIB (T3/4N2). Stage IIIA were divided into two subsets according to tumor localization (T3N1-T4N0/1, IIIA-T group; n = 308) and extension of nodal disease (T1/2N2, IIIA-N2 group; n = 116). Survival rate was compared with another Thoracic Surgery Center database for validation.

Result:

IIIA-N2 group had more adenocarcinoma than IIIA-T group (52.6% vs. 29.5%, p < 0.001), and pneumonectomy was more performed in IIIA-T group (51.0% vs. 32.8%, p = 0.001). In multivariate analysis, N2 and age > 65 were significant independent negative prognostic factors (p < 0.0001). Five-year survival for patients in IIIA-T group was 51.3% (median 64 months), whereas it was 25.7% (median 31 months) for IIIA-N2 patients (HR: 1.834, 95%CI [1.345 – 2.501], p < 0.0001) (Figure 1). There was no statistically difference regarding the survival between IIIA-N2 and Stage IIIB (25.7% vs. 25.3%, p = 0.4). According to the results, we performed a re-staging for Validation Cohort patients as; Stage IIIA-T (including T3N1 and T4N0/1) (n = 139), Stage IIIA-N (including T1/2N2) (n = 104), and Stage IIIB (n = 50). Stage IIIA-T had a statistically better survival than Stage IIIA-N (50.5% vs. 27.1%, HR: 1.707, 95%CI [1.231 – 2.366], p = 0.0007), whereas five-year survival rates were similar for Stage IIIA-N and Stage IIIB (27.1% vs. 27.1%, p = 0.9) (Figure 2).

Zoom Image
Fig. 1: Survival comparison between IIIA-T group. IIIA-N2 group, and Stage IIIB
Zoom Image
Fig. 2: Survival curves of proposed-stage IIIA-T (including T3N1 and T4N0/1), proposed-stage IIIA-N (including T1/2N2), and Stage IIIB (including T3/4N2) for Validation Cohort

Conclusion:

We propose to divide stage IIIA into two different subgroups according to the primary tumor extension (T) and mediastinal lymph node involvement (N) in the next TNM classification. This allows better patient selection for resection.