A Population-Based Study of Outcomes in Surgically Resected T3N0 Non–Small Cell Lung Cancer in The Netherlands, Defined Using TNM-7 and TNM-8; Justification of Changes and an Argument to Incorporate Histology in the Staging Algorithm

Abstract

Objective: The objective was to study outcomes in patients in a population registry who were surgically staged as having pT3N0 NSCLC according to the seventh and eighth editions of the TNM staging classification. Methods: Details of patients who underwent surgery for NSCLC staged as pT3N0M0 from 2010 to 2013 on the basis of the seventh edition of the TNM classification were retrieved from the Netherlands Comprehensive Cancer Organization. These data were next matched with corresponding pathology data from a nationwide registry. Patients were categorized into four major pT3 subgroups as follows: those with a tumor diameter more than 7 cm, those with separate tumor nodules in the same lobe (two or more nodules), those with parietal pleural invasion, and a mixed group (consisting mainly of those with a tumor diameter larger than 7 cm combined with parietal pleural invasion). Results: A total of 683 patients were eligible for analysis. The 3-and 5-year overall survival (OS) rates for the subtype tumor diameter larger than 7 cm were 59.9% and 47.2%, respectively, and were comparable to the rates for the subtype with pleural invasion (50.4% and 45.3%), respectively. The mixed group had worse 3-and 5-year OS rates (37.5% and 28.7%, respectively), which were comparable to the outcomes for TNM eighth edition-staged IIIB and pT4 cases in the International Association for the Study of Lung Cancer database. For the subtype two or more nodules, the 3-and 5year OS rates were 70.6% and 62.8%, respectively, with patients with adenocarcinoma showing a significantly better OS than did patients with squamous cell carcinoma: a 5-year OS rate of 65.1% versus 47.2%, respectively (p < 0.001), suggesting that the prognosis for the adenocarcinoma subgroup may be comparable to that for the pT2 category, whereas squamous cell carcinoma nodules can remain pT3. Conclusion: This population analysis of overall survival rate by pT3N0 subcategory for NSCLC suggests that

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

“…These findings are consistent with a recent study in the Netherlands by Blaauwgeers et al 7 Dividing their pT3N0 cohort into four subtypes (size >7 cm, 2 nodules, parietal pleural invasion, and "mixed"), the authors similarly found that the greater than or equal to two nodule criterion was associated with greater 5-year OS than all other T3 descriptors. Importantly, this study also reported that patients with "mixed" pT3N0 NSCLC (i.e., two concurrent T3 descriptors) had the lowest 3-and 5year OS.…”

“…These results identified a potential gap within eighth edition stage groupings, and the authors thereby suggested that the combination of two T3 criteria should be evaluated for upgrading as a T4 descriptor in the next classification system. [5][6][7] With the advantage of a larger sample size, this study offers evidence to support conclusions of Blaauwgeers et al 7 regarding the considerable prognostic implications of multiple-T3 pT3N0 NSCLC. Furthermore, the survival disparity observed between single-T3 versus multiple-T3 pT3N0 NSCLC arguably follows a logical pattern; if each criterion is individually sufficient to deem a T3 designation, it is reasonable to anticipate that a combination of T3 descriptors would portend greater disease severity than an isolated T3 descriptor.…”

“…Within the pT3N0 NSCLC cohort, adjuvant chemotherapy was associated with a 35% reduced risk of death yet was received by only 40.1% of patients (Tables 1 and 2). Blaauwgeers et al 7 similarly found that only 38.7% of pT3N0 patients received postoperative chemotherapy despite a demonstrated survival benefit.…”

Outcomes of Survival Analysis of Patients who Operated for NSCLC According to Subgroups of pT3 Tumors.

“…(6). Blaauwgeers ve ark T3N0 akciğer kanseri ile ilgili yaptıkları çalışmada en kötü prognozun miks alt grupta olduğunu en iyi prognozun ise satellit nodül grubunda olduğunu saptamışlardır (7). Çalışmamızda invazyon ve miks grubun prognozu çap grubuna göre daha kötü bulunmuştur.…”

Comparison of the 7th and 8th Edition of the UICC/AJCC TNM Staging System in Primary Resected Squamous Cell Carcinomas of the Lung—A Single Center Analysis of 354 Cases

“…Several groups from Asia and North America have validated the data in mixed cohorts of non-small cell lung cancer, showing mostly improved prognostication for TNM8 (Table 1) (8–14). Of note, in a large population based European study on resected T3N0 NSCLC improved prognostication of TNM8 depended on histological tumor typing (15). SQCC is usually underrepresented in mixed cohorts (Table 1).…”