The IASLC Lung Cancer Staging Project: Analysis of Resection Margin Status and Proposals for Residual Tumor Descriptors for Non–Small Cell Lung Cancer

Abstract

Objective: Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un).Methods: A total of 14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: whether fewer than three N2 stations

Thymic Epithelial Tumors as a Model of Networking: Development of a Synergistic Strategy for Clinical and Translational Research Purposes

“…Moreover, our Institute is well-known as an Italian expert center for the surgical and multimodality approach applied for the removal of mediastinal masses (25). At present, we play an active leading role in TYME, the main Italian network for thymic tumor management (17,64), and we will be contributing to the ongoing ninth TNM staging project of thymic tumors and lung carcinoma, expected in 2024 (65,66). In EURACAN, the G8 network, we contribute to ongoing activities in the clinical patient management system (CPMS), a web-based complex clinical software, and to the Digital Pathology Task force, and research projects are moving forward (16); currently, EURACAN in conjunction with the European Organization for Research on Cancer (EORTC) are moving ahead.…”

Propensity-Matched Analysis of Clinical Relevance of the Highest Mediastinal Lymph Node Metastasis

“…5 However, this result is contrary to the finding of the IASLC Lung Cancer Staging Project database study published by Edwards and colleagues. 9 They found that for N2-positive patients assigned R0 status by the submitting unit, a significant difference in survival was observed between those with HMLL-positive and HMLL-negative NSCLC (median survival, 41 versus 55 months, respectively). Similarly, Zheng and colleagues 6 noticed a trend toward worse survival among patients with HMLL-positive NSCLC.…”

“…A recent study reported that 56% of 14,712 NSCLC patients underwent uncertain resection in the IASLC Lung Cancer Staging Project database. 9 The reason why HMLL metastasis is regarded as a subcategory of uncertain resection is that the pathological status of the node is unknown, and thus the completeness of the resection cannot be guaranteed. 2 It is reasonable to hypothesize that if the tumor affects the HMLL, tumor cells may further drain into more higher lymph nodes, such as supraclavicular lymph nodes 10 or even the bloodstream, which might lead to a higher risk for cancer recurrence or metastasis, and eventually result in a bad prognosis.…”

“…For example, the study by Park and coworkers defined 2R of the right side and 4L or 6 of the left side as HMLL, whereas Zheng and colleagues defined either 1R or 2R on the right side and 4L on the left side as HMLL. The definition of HMLL in the study of Edwards and coworkers 9 was probably the simplest: the station with the lowest numerically number was considered the highest. Apart from the definition of HMLL, other selection biases might exist; for instance, patients who received neoadjuvant therapy were excluded only in the study of Edwards and colleagues.…”

“…Apart from the definition of HMLL, other selection biases might exist; for instance, patients who received neoadjuvant therapy were excluded only in the study of Edwards and colleagues. 9 Selection biases were inevitable, although propensity score matching was performed to balance the baseline characteristics in the current study. Next, doubtless a small study size is associated with weak statistical power, an overestimation of the effect size, and a low probability of ensuring the reproducibility of results.…”