Validation of the Stage Groupings in the Eighth Edition of the TNM Classification for Lung Cancer

Sui, Xizhao; Jiang, Wei; Chen, Haiqing; Yang, Fan; Wang, Jun; Wang, Qun

doi:10.1016/j.jtho.2017.07.028

Cited by 28 publications

(21 citation statements)

References 30 publications

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“…To predict the clinical significance of CD44 expression, we analyzed the associations between CD44 expression and clinicopathological features in NSCLC. There was no significant difference between CD44 expression and age, sex, smoking status, pathology type, N classification or TNM stage ( 22 ). However, the level of CD44 expression was positively associated with an advanced T classification (P<0.05; Table I ).…”

Section: Resultsmentioning

confidence: 94%

CD44 promotes cell proliferation in non-small cell lung cancer

Yang

et al. 2018

Oncol Lett

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Cluster of differentiation 44 (CD44), a marker for cancer stem cells, has been reported to be associated with poor prognosis in non-small cell lung cancer (NSCLC), but its involvement in tumor growth has not fully been elucidated. The present study explored the associations between CD44 expression and clinicopathological features using immunohistochemistry in 94 NSCLC cases, as well as proliferation in cells with aberrant expression of this protein. Overexpression of CD44 was achieved by transfecting H1299 cells with CD44 expression vectors, and inhibition of CD44 expression was performed by transfecting small interfering RNAs into A549 cells. Cell proliferation was measured using Cell Counting Kit-8 assays and flat plate colony formation assay was performed to confirm the cellular anchorage growth in vitro. In total, 64 (68.1%) of the 94 NSCLC cases stained positive for CD44 expression. High expression of CD44 was associated with advanced T stage in NSCLC. Overexpression of CD44 in H1299 cells promoted cell proliferation and colony formation in vitro. Meanwhile, knockdown of CD44 expression in A549 cells suppressed cell proliferation and colony formation in vitro. High expression of CD44 may promote NSCLC progression by increasing cancer cell proliferation; therefore, it may serve as a potential biomarker for diagnosis or target therapy.

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Section: Resultsmentioning

confidence: 94%

CD44 promotes cell proliferation in non-small cell lung cancer

Yang

et al. 2018

Oncol Lett

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“…Thus, it is important to determine the prognostic effect of EGFR mutation after adjusting for these variables in order to prevent false positive or false negative results. In this context, one of the strengths of the present study was that pathological stage, adenocarcinoma subtype, and solid portion size, all of which are powerful prognostic factors with a potential association with EGFR mutation, were included in the analysis . The substantial discrepancy between the current study findings and the reported results in the literature might be attributable to differences in the included variables.…”

Section: Discussionmentioning

confidence: 77%

The prognostic implications of EGFR mutation and ALK rearrangement for the long‐term outcomes of patients with resected lung adenocarcinomas

et al. 2019

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Background To investigate the prognostic impact of epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement for the overall survival (OS) of patients with surgically treated lung adenocarcinomas. Methods A total of 689 patients with stage I–III lung adenocarcinomas (male:female = 334:355; median age, 64 years) underwent complete surgical resection between 2007 and 2013. The prognostic impact of EGFR mutation and ALK rearrangement on OS was analyzed using Cox regression analysis. Certain clinicopathological prognostic factors (i.e., age, sex, smoking status, nodule type, solid portion size, pathologic stage, adenocarcinoma subtype, and history of adjuvant chemotherapy) were included for adjustments of the hazard ratio (HR). Results EGFR mutation was observed in 438 patients (64%) and ALK rearrangement was seen in 28 patients (4%). Multivariable‐adjusted Cox regression demonstrated that the prognostic effect of EGFR mutation on OS differed by age (HR, exp.[−5.199 + 0.064*age]). The adjusted HR for EGFR mutation was 0.14 (95% CI: 0.05–0.36; P < 0.001) at 50 years, 0.26 (95% CI: 0.15–0.46; P < 0.001) at 60 years, and 0.50 (95% CI: 0.31–0.81; P = 0.005) at 70 years. However, the effect of ALK rearrangement on OS was without statistical significance (P > 0.05). Conclusions EGFR mutation was independently prognostic of the long‐term outcomes of patients with surgically treated lung adenocarcinomas. A more favorable prognostic effect was seen in younger than in older patients. ALK rearrangement was not associated with OS.

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“…The TNM staging system of the 8 th edition AJCC, demonstrated better survival stratification of T staging than the 7 th edition (10,11). Stage N2 disease was separated into subgroups of stage IIIA and IIIB depending on whether T1-2 or T3-4 was present.…”

Section: Discussionmentioning

confidence: 99%

Tumor size as a predictor for prognosis of patients with surgical IIIA-N2 non-small cell lung cancer after surgery

et al. 2021

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Background: The 8 th edition of the American Joint Committee on Cancer staging system for lung cancer made major revisions to T staging, especially the size division of stage II/III patients. However, the value of tumor size in the postoperative prognosis of IIIA-N2 non-small cell lung cancer (NSCLC) is seldom mentioned, and survival data of such patients should be re-evaluated according to the 8 th edition staging system. Methods: Patients with IIIA-N2 NSCLC after surgery were identified in the Surveillance, Epidemiology, and End Results database (n=4,128). All patients were stratified according to tumor size, 5-year overall survival (OS) was then compared. Cox regression analysis was used to determine the value of size to discriminate patients with prognostic differences and establish a predictive nomogram system. Patients with IIIA-N2 NSCLC from our own institute (n=583) were used to validate the results. Results: The prognosis of patients with tumor sizes of 0-2, 2-4 and 4-5 cm differed greatly from each other in the training cohort, with 5-year OS rates of 53.7%, 43.9% and 36.9% respectively (P<0.001), in the validation cohort, the rates were 54.1%, 38.4% and 33.8% respectively. Tumor size >2 cm was considered an independent risk factor compared to the ≤2 cm group in the Cox regression analysis: 2-4 cm (HR =1.25, 1.12-1.39; P<0.001), 4-5 cm (HR =1.51, 1.32-1.39; P<0.001), the validation cohort showed the same trend.The concordance index of the training set was 0.634 (0.622-0.646), while that of the validation set was 0.716 (0.686-0.746). The calibration plot showed optimal consistency between the nomogram predicted survival and observed survival. Conclusions: Tumors with different sizes showed significant postoperative survival differences among patients with IIIA-N2 NSCLC. Tumor size should be considered when making surgery decisions in such patients, with tumor size ≤2 cm showing considerably better prognosis.

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Validation of the Stage Groupings in the Eighth Edition of the TNM Classification for Lung Cancer

Abstract: This study provided an external validation of the stage groupings in the eighth edition of the TNM classification for lung cancer among surgically treated Chinese patients with NSCLC.

Cited by 28 publications

References 30 publications

CD44 promotes cell proliferation in non-small cell lung cancer

CD44 promotes cell proliferation in non-small cell lung cancer

The prognostic implications of EGFR mutation and ALK rearrangement for the long‐term outcomes of patients with resected lung adenocarcinomas

Tumor size as a predictor for prognosis of patients with surgical IIIA-N2 non-small cell lung cancer after surgery

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