Importance of tumor size in resectable stage III-N2 non–small cell lung cancer
Date
2022
Type:
Article
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Abstract
Objective
The 8th TNM edition classifies stage III-N2 disease as IIIA and IIIB based on a tumor size cutoff of 5 cm. However, the importance of tumor size on survival in patients with resectable stage III-N2 disease has not been analyzed systematically.
Methods
Survival analysis based on tumor size (>5 cm vs ≤ 5 cm) for 255 consecutive patients with nonbulky (maximal lymph node diameter of 1.5 cm) stage III-N2 non–small cell lung cancer treated with surgery in our institution.
Results
Ninety patients (35.3%) underwent induction chemoradiation therapy (n = 72, 28%) or induction chemotherapy (n = 18, 7%), and 165 patients underwent primary surgery followed by adjuvant chemotherapy (n = 52, 32%), adjuvant chemoradiation therapy (n = 47, 29%), or adjuvant radiation therapy (n = 14, 13.2%). After a median follow-up of 6.5 years, the overall survival was 46.5% at 5 years and 28.9% at 10 years. In tumors 5 cm or less, there was no difference in survival between patients treated with induction or adjuvant therapy. However, in tumors greater than 5 cm, the survival was significantly better after induction therapy compared with adjuvant therapy or surgery alone. Pathologic multi-station N2 disease was more frequently detected in tumors greater than 5 cm (31% vs 18% in tumors ≤5 cm, P = .042), and the rate of R1 resection was lower after induction therapy (2.2% vs 8.5% in primary surgery, P = .048).
Conclusions
These results support the redefinition of tumors greater than 5 cm with resectable N2 disease to stage IIIB. This change should help to refine the multimodality approach for stage III-N2 lung cancer.
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Citation
Pablo Perez Castro, Marc de Perrot, Yang Chong Chua, Andrea Bezjak, Natasha Leighl, Gail Darling, Andrew Pierre, Kazuhiro Yasufuku, Marcelo Cypel, Thomas Waddell, Laura Donahoe, Jonathan Yeung, Shaf Keshavjee, Importance of tumor size in resectable stage III-N2 non–small cell lung cancer, The Journal of Thoracic and Cardiovascular Surgery, 2022, , ISSN 0022-5223, https://doi.org/10.1016/j.jtcvs.2022.02.015.
Keywords
Lung cancer chemotherapy, Lung cancer radiation, Non–small cell lung cancer, N2 disease, Thoracic surgery