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DOI: 10.1055/a-1209-3668
Prognostic Factors and Survival in Resected T4 Non-small Cell Lung Cancer: Is There Any Difference in the T4 Subgroups?
Prognosefaktoren und Überleben bei reseziertem T4 nicht kleinzelligem Lungenkarzinom: Gibt es einen Unterschied in den T4-Untergruppen?![](https://www.thieme-connect.de/media/zblchir/202103/lookinside/thumbnails/10-1055-a-1209-3668_zbc1617-1.jpg)
Abstract
Introduction The eighth edition of the TNM classification revised the subgroups of T4 non-small cell lung cancer (NSCLC). This study aimed to compare the T4-NSCLC subgroups that underwent surgical treatment in terms of mortality, morbidity, survival, and prognostic factors based on the new classification.
Materials and Methods Between 2000 and 2014, a total of 284 T4-NSCLC patients who underwent lung resection (mediastinal organ invasion, n = 114; ipsilateral different lobe tumors, n = 32; and tumors larger than 7 cm, n = 138) were included in the present study.
Results Surgical mortality and morbidity were 5.6% (n = 16) and 23.9% (n = 68), respectively. The 5-year survival rates were 46% for ipsilateral different lobe tumors, 45.4% for tumours larger than 7 cm, and 36.6% for mediastinal organ invasion (28% for patients with heart/atrium invasion, 43.3% for carina invasion, 37.5% for large vessel invasion) (p = 0.223). Age above 65 (p = 0.002, HR = 1.781), pN2 versus pN0/1 (p < 0.0001, HR = 2.564), incomplete resection (p = 0.003, HR = 2.297), and pneumonectomy (p = 0.02, HR = 1.524) were identified as poor prognostic survival factors. According to multivariate analysis, mediastinal lymph node metastasis (p = 0.001) and incomplete resection (p = 0.0026) were the independent negative risk factors for survival.
Conclusion According to the results of our study, surgical treatment is a good option in T4-NSCLC patients who have no mediastinal lymph node metastasis and are completely resectable. There is no difference in terms of survival among the T4 subgroups. The eighth edition of the TNM classification has a better prognostic definition than the previous version.
Zusammenfassung
Einführung Die achte Ausgabe der TNM-Klassifikation wurde in Bezug auf die Untergruppen von T4 nicht kleinzelligem Lungenkarzinom (NSCLC) überarbeitet. Diese Studie zielte darauf ab, die T4-NSCLC-Untergruppen zu vergleichen, die chirurgische Behandlung in Bezug auf Mortalität, Morbidität, Überlebens- und Prognosefaktoren basierend auf der neuen Klassifikation.
Materialen und Methoden Zwischen 2000 und 2014 wurden insgesamt 284 T4-NSCLC-Patienten, die sich einer Lungenresektion unterzogen hatten (Invasion der mediastinalen Organe, n = 114; ipsilaterale Tumoren verschiedener Lappen, n = 32; Tumoren größer als 7 cm, n = 138), in die vorliegende Studie eingeschlossen.
Ergebnisse Die chirurgische Mortalität und Morbidität betrug 5,6% (n = 16) und 23,9% (n = 68). Die 5-Jahres-Überlebensrate betrug 46% bei ipsilateralen verschiedenen Lappen Tumoren, 45,4% bei Tumoren größer als 7 cm und 36,6% bei mediastinaler Organinvasion (28% bei Patienten mit Herz-/ Vorhofinvasion, 43,3% bei Karinainvasion, 37,5% bei großer Gefäß Invasion) (p = 0,223). Alter über 65 (p = 0,002, HR = 1,781), pN2 gegenüber pN0/1 (p < 0,0001, HR = 2,564), unvollständige Resektion (p = 0,003, HR = 2,297) und Pneumonektomie (p = 0,02, HR = 1,524) wurden als schlechte prognostische Überlebensfaktoren identifiziert. Gemäß multivariater Analyse waren mediastinale Lymphknotenmetastasen (p = 0,001) und unvollständige Resektionen (p = 0,0026) die unabhängigen negativen Risikofaktoren für das Überleben.
Schlussfolgerung Nach den Ergebnissen unserer Studie ist eine chirurgische Behandlung eine gute Option bei T4-NSCLC-Patienten, die keine mediastinale Lymphknotenmetastasierung aufweisen und vollständig resezierbar sind. Es gibt keinen Unterschied in Bezug auf das Überleben zwischen den T4-Untergruppen. Die achte Ausgabe der TNM-Klassifikation hat eine bessere prognostische Definition als die vorherige Version.
Key words
surgical treatment - survival - prognostic factors - T4 non-small cell lung cancer - surgical treatment - survival - prognostic factorsSchlüsselwörter
chirurgische Behandlung - Überleben - prognostische Faktoren - T4 nicht kleinzelliges Lungenkarzinom - chirurgische Behandlung - Überleben - prognostische FaktorenPublikationsverlauf
Artikel online veröffentlicht:
03. August 2020
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