Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Zhang K

PROVIDER: S-EPMC8339790 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

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

Zhang Kunpeng K Cai Jiahao J Lu Chunlai C Zhu Qiaoliang Q Zhan Cheng C Shen Yaxing Y Gu Jie J Ge Di D

Journal of thoracic disease 20210701 7

<h4>Background</h4>The 8<sup>th</sup> 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<sup>th</sup> edition staging system.<h4>Methods</h4>Patients with IIIA-N2 NSCLC aft ...[more]

PMID: 34422341

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Project description:BackgroundCompletely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) comprises a heterogeneous population according to discrepancies in survival prognosis. Accumulating evidence suggests that tumor-infiltrating lymphocytes (TILs) are clinically significant, despite a lack of consensus regarding the immunoscore (IS) in NSCLC. Here, we determined the prognostic value of the immune microenvironment as an IS in a uniform cohort of patients with completely resected stage IIIA(N2) NSCLC.MethodsConsecutive patients with pathologically confirmed stage IIIA(N2) NSCLC and who underwent complete resection (2005-2012) were retrospectively reviewed. Tissue microarrays (TMAs) were constructed from surgical paraffin-embedded primary lung tumor specimen. For each case, two representative regions from the tumor center (CT) and two from the invasive margin (IM) containing the highest density of lymphocytes were selected. Densities of CD3+, CD45RO+, and CD8+ lymphocytes were assessed using immunohistochemistry (IHC) by specialized pathologists according to predefined scoring scales. Patients were classified according to IS definition based on TIL type, density, and distribution, and relationships between IS and prognosis were evaluated.ResultsPatients (N = 288) with complete IHC-based TMA spots were included. Univariate analyses showed that CD3+ T cell density was associated with neither overall survival (OS) nor distant metastasis-free survival (DMFS), whereas CD45RO+ T cell density in the IM was a significant prognostic factor for DMFS (p = 0.02) and was predictive of OS (p = 0.05). Combined CD45RO+ and CD8+ cell infiltration in tumor regions (CT and IM) significantly improved IS prognostic impact. Multivariate analyses revealed IS as an independent prognostic predictor for both DMFS (p = 0.001) and OS (p = 0.002).ConclusionThe proposed IS might provide valuable prognostic information, including prediction of DMFS and OS in stage IIIA(N2) NSCLC patients. Larger patient cohorts are needed to validate this IS classification, which might assist with accurate risk stratification and treatment decisions.

Dataset Information

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

Background

Methods

Results

Conclusions

Publications

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

Similar Datasets

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