Prognostic Factors and Survival in Resected T4 Non-small Cell Lung Cancer: Is There Any Difference in the T4 Subgroups?

Abstract

Introduction The eighth edition of the TNM classification revised the subgroups of T4 non-small cell lung cancer (NSCLC). This study aimed to compare the T4-NSCLC subgroups that underwent surgical treatment in terms of mortality, morbidity, survival, and prognostic factors based on the new classification.

Materials and Methods Between 2000 and 2014, a total of 284 T4-NSCLC patients who underwent lung resection (mediastinal organ invasion, n = 114; ipsilateral different lobe tumors, n = 32; and tumors larger than 7 cm, n = 138) were included in the present study.

Results Surgical mortality and morbidity were 5.6% (n = 16) and 23.9% (n = 68), respectively. The 5-year survival rates were 46% for ipsilateral different lobe tumors, 45.4% for tumours larger than 7 cm, and 36.6% for mediastinal organ invasion (28% for patients with heart/atrium invasion, 43.3% for carina invasion, 37.5% for large vessel invasion) (p = 0.223). Age above 65 (p = 0.002, HR = 1.781), pN2 versus pN0/1 (p < 0.0001, HR = 2.564), incomplete resection (p = 0.003, HR = 2.297), and pneumonectomy (p = 0.02, HR = 1.524) were identified as poor prognostic survival factors. According to multivariate analysis, mediastinal lymph node metastasis (p = 0.001) and incomplete resection (p = 0.0026) were the independent negative risk factors for survival.

Conclusion According to the results of our study, surgical treatment is a good option in T4-NSCLC patients who have no mediastinal lymph node metastasis and are completely resectable. There is no difference in terms of survival among the T4 subgroups. The eighth edition of the TNM classification has a better prognostic definition than the previous version.

Zusammenfassung

Einführung Die achte Ausgabe der TNM-Klassifikation wurde in Bezug auf die Untergruppen von T4 nicht kleinzelligem Lungenkarzinom (NSCLC) überarbeitet. Diese Studie zielte darauf ab, die T4-NSCLC-Untergruppen zu vergleichen, die chirurgische Behandlung in Bezug auf Mortalität, Morbidität, Überlebens- und Prognosefaktoren basierend auf der neuen Klassifikation.

Materialen und Methoden Zwischen 2000 und 2014 wurden insgesamt 284 T4-NSCLC-Patienten, die sich einer Lungenresektion unterzogen hatten (Invasion der mediastinalen Organe, n = 114; ipsilaterale Tumoren verschiedener Lappen, n = 32; Tumoren größer als 7 cm, n = 138), in die vorliegende Studie eingeschlossen.

Ergebnisse Die chirurgische Mortalität und Morbidität betrug 5,6% (n = 16) und 23,9% (n = 68). Die 5-Jahres-Überlebensrate betrug 46% bei ipsilateralen verschiedenen Lappen Tumoren, 45,4% bei Tumoren größer als 7 cm und 36,6% bei mediastinaler Organinvasion (28% bei Patienten mit Herz-/ Vorhofinvasion, 43,3% bei Karinainvasion, 37,5% bei großer Gefäß Invasion) (p = 0,223). Alter über 65 (p = 0,002, HR = 1,781), pN2 gegenüber pN0/1 (p < 0,0001, HR = 2,564), unvollständige Resektion (p = 0,003, HR = 2,297) und Pneumonektomie (p = 0,02, HR = 1,524) wurden als schlechte prognostische Überlebensfaktoren identifiziert. Gemäß multivariater Analyse waren mediastinale Lymphknotenmetastasen (p = 0,001) und unvollständige Resektionen (p = 0,0026) die unabhängigen negativen Risikofaktoren für das Überleben.

Schlussfolgerung Nach den Ergebnissen unserer Studie ist eine chirurgische Behandlung eine gute Option bei T4-NSCLC-Patienten, die keine mediastinale Lymphknotenmetastasierung aufweisen und vollständig resezierbar sind. Es gibt keinen Unterschied in Bezug auf das Überleben zwischen den T4-Untergruppen. Die achte Ausgabe der TNM-Klassifikation hat eine bessere prognostische Definition als die vorherige Version.

Key words

surgical treatment - survival - prognostic factors - T4 non-small cell lung cancer - surgical treatment - survival - prognostic factors

Schlüsselwörter

chirurgische Behandlung - Überleben - prognostische Faktoren - T4 nicht kleinzelliges Lungenkarzinom - chirurgische Behandlung - Überleben - prognostische Faktoren

Publication History

Article published online:
03 August 2020

• References

• 1 Goldstraw P, Chansky K, Crowley J. et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 2016; 11: 39-51
• 2 Li Q, Zhang P, Wang Y, Liu D. et al. T4 extension alone is more predictive of better survival than a tumour size > 7 cm for resected T4N0–1M0 non-small-cell lung cancer. Eur J Cardiothorac Surg 2018; 55: 682-690
• 3 Yamanashi K, Menju T, Hamaji M. et al. Prognostic factors related to postoperative survival in the newly classified clinical T4 lung cancer. Eur J Cardiothorac Surg 2020; 57: 754-761
• 4 Yamamoto K, Kosaba S, Ikeda T. Tumors involving the tracheal carina: new technique of carinal reconstruction. Ann Thorac Surg 2000; 70: 1419-1422
• 5 Sayar A, Solak O, Metin M. et al. Carinal resection and reconstruction for respiratory tumors using Miyamotoʼs technique. Gen Thorac Cardiovasc Surg 2012; 60: 90-96
• 6 Rami-Porta R, Ball D, Crowley J. et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2007; 2: 593-602
• 7 Dartevelle PG, Mitilian D, Fadel E. Extended surgery for T4 lung cancer: a 30 yearsʼ experience. Gen Thorac Cardiovasc Surg 2017; 65: 321-328
• 8 Yıldızeli B, Dartevelle PG, Fadel E. et al. Results of primary surgery with t4 non–small cell lung cancer during a 25-year period in a single center: the benefit is worth the risk. Ann Thorac Surg 2008; 86: 1065-1075
• 9 Spaggiari L, Leo F, Veronesi G. et al. Superior vena cava resection for lung and mediastinal malignancies: a single-center experience with 70 cases. Ann Thorac Surg 2007; 83: 223-230
• 10 Mu JW, Lü F, Wang YG. et al. Surgical results of T4 lung cancer invading left atrium and great vessels. Zhonghua Yi Xue Za Zhi 2008; 88: 383-386
• 11 Pitz CCM, de la Rivière AB, van Swieten HA. et al. Results of surgical treatment of T4 non-small cell lung cancer. Eur J Cardiothorac Surg 2003; 24: 1013-1018
• 12 Izbicki JR, Knoefel WT, Passlick B. et al. Risk analysis and long-term survival in patients undergoing extended resection of locally advanced lung cancer. J Thorac Cardiovasc Surg 1995; 110: 386-395
• 13 de Perrot M, Fadel E, Mercier O. et al. Long-term results after carinal resection for carcinoma: does the benefit warrant the risk?. J Thorac Cardiovasc Surg 2006; 131: 81-89
• 14 Çitak N, Buyukkale S, Sayar A. et al. Prognostic factors and survival in patients undergoing surgery for T4 nonsmall cell lung carcinoma. Acta Chir Belg 2014; 114: 17-24
• 15 Silvestri GA, Gonzalez AV, Jantz MA. et al. Methods for staging non-small cell lung cancer: diagnosis and management of lung cancer: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143: e211S-e250S
• 16 de Langen AJ, Raijmakers P, Riphagen I. et al. The size of mediastinal lymph nodes and its relation with metastatic involvement: a meta-analysis. Eur J Cardiothorac Surg 2006; 29: 26-29
• 17 Osaki T, Sugio K, Hanagiri T. et al. Survival and prognostic factors of surgically resected T4 non-small cell lung cancer. Ann Thorac Surg 2003; 75: 1745-1751
• 18 Ohta M, Hirabayasi H, Shiono H. et al. Surgical resection for lung cancer with infiltration of the thoracic aorta. J Thorac Cardiovasc Surg 2005; 129: 804-808
• 19 Bernard A, Bouchot O, Hagry O. et al. Risk analysis and long-term survival in patients undergoing resection of T4 lung cancer. Eur J Cardiothorac Surg 2001; 20: 344-349
• 20 Misthos P, Papagiannakis G, Kokotsakis J. et al. Surgical management of lung cancer invading the aorta or the superior vena cava. Lung Cancer 2007; 56: 223-227
• 21 Bobbio A, Carbognani P, Grapeggia M. et al. Surgical outcome of combined pulmonary and atrial resection for lung cancer. Thorac Cardiovasc Surg 2004; 52: 180-182
• 22 Bryant AS, Pereira SJ. Miller DL et al ·. Satellite pulmonary nodule in the same lobe (T4N0) should not be staged as IIIB non–small cell lung cancer. Ann Thorac Surg 2006; 82: 1808-1814
• 23 Yang H, Hou X, Lin P. et al. Survival and risk factors of surgically treated mediastinal invasion T4 non-small cell lung cancer. Ann Thorac Surg 2009; 88: 372-378