T components of the current 8th edition of lung cancer American Joint Commission on Cancer (AJCC) staging assignment include size of primary tumor and others such as chest wall invasion. The role of the presence of multiple T3 descriptors in prognosis remains unknown.
Materials and methods
Using National Cancer Database (NCDB) and of AJCC 7th edition, pathologically staged (R0) N0M0 non-small cell lung cancer (NSCLC) cases diagnosed in 2010-2016 were analyzed. Selected cases had primary size larger than 5cm or staged as T3 by AJCC 7th edition despite size <5cm. T3 descriptor status by 8th edition was defined as single descriptor (“T3-single”) as primary size 5-7cm or size <5cm and T3 per 7th edition (“T3-other”), or multiple descriptor (“T3-multi”) as presence of both descriptors. Survival analysis was performed with validation of multivariate analyses.
Of the 108,632 surgically resected pathologically staged N0M0R0 NSCLC cases, 9,931 met the following criteria: 8,955 as T3 Single (4,381 as T3 Size, 4,574 as T3 Other), and 884 as T3 Multi. Univariate and multivariate analyses demonstrated that T3 Multi had significantly worse overall survival than T3 Single with median survival of 37.3 vs. 69.3 months, respectively. Propensity score matching analysis validated statistical significance. Exploratory analysis also demonstrated that survival of T3 Multi group is similar to that of T4 groups.
Our retrospective analysis using NCDB suggests that prognosis of patients with multiple T3 descriptors is significantly worse than those with single descriptors. Further research may be required to accurately define prognosis of NSCLC for future staging update.
JTO Clinical and Research Reports
Komiya, Takefumi MD; Powell, Emily PhD; and Takamori, Shinkichi MD PhD, "Prognostic impact of single and multiple descriptors in pathologically staged T3N0M0 non-small cell lung cancer" (2020). PCI Publications and Projects. 46.