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

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

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Article number100186
JournalJTO Clinical and Research Reports
Volume2
Issue number6
DOIs
StatePublished - Jun 2021
Externally publishedYes

Keywords

  • Classification
  • Lung cancer
  • Staging
  • T3

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

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