1. Survival and Prognostic Factors of Resected T3N0M0 NSCLC

T3N0M0型非小細胞肺癌切除術後的生存和預後因素

Introduction
介紹

The 8^th Edition T3N0M0 category represents a heterogeneous group of Non-Small Cell Lung Cancers (NSCLC). This study aims to compare the oncologic outcomes of individual T3 features.

8 The condition T3N0M0 category代表非小細胞肺癌(NSCLC)的異質性組。本研究旨在比較個體T3特征的腫瘤預後。

Methods
研究方法

Between 2001 and 2019, 293 consecutive pT3N0M0 NSCLC patients according to the 8^th lung cancer TNM classification were enrolled. Neo-adjuvant chemotherapy cases and Pancoast tumors were excluded. Patients were grouped according to the T3 features in one of four categories: (1) Chest Wall Infiltration (CWI), (2) Size (> 5cm to ≤ 7cm), (3) presence of Satellite Nodule and (4) All Other T3 features. Patients with multiple features were grouped in a separate category, and then regrouped after exploring interactions between features. Any CWI was classified in Group 1 regardless of other T3 features, and Size plus any T3 feature other than CWI in Group 2. Multivariable regression models were developed to determine associations of clinical factors with oncologic outcomes. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan-Meier and Cox proportional hazard analyses.

從2001年到2019年，根據8種肺癌TNM分型，共納入293例pT3N0M0非小細胞肺癌患者。排除新輔助化療和Pancoast腫瘤。根據T3特征將患者分為四類:(1)胸壁浸潤(CWI)，(2)大小(> 5cm至≤7cm)，(3)存在衛星結節和(4)所有其他T3特征。有多個特征的患者被分組到一個單獨的類別中，然後在探索特征之間的相互作用後重新分組。任何CWI都被歸為1組，而不考慮其他T3特征，而Size加上除CWI以外的任何T3特征歸為2組。開發了多變量回歸模型來確定臨床因素與腫瘤預後的關係。使用Kaplan-Meier和Cox比例風險分析估計總生存期(OS)和無病生存期(DFS)。

Results
結果

Among the 293 eligible patients, 51,9 % were males with a mean age of 68 years old. Lobectomy was performed in 91,5 % of cases (n=268) and 56 % (n=164) of NSCLC were adenocarcinoma. Between the T3 categories, Size and Satellite Nodule were the most common in 59% (n=172) and 28% (n=81) of cases respectively. Local and distant recurrences occurred in 10,6% (n=31) and 14% (n=41) of patients, while 6,8% (n=20) had both types of recurrences. After multivariable adjustments: age over 65 (p=0,005), male gender (p=0,007), CWI (p=0,002), larger tumors (p=0,047) and incomplete resections (p=0,03) were associated with worse OS. The same variables were associated with worse DFS (p<0,05) except for incomplete resections (p=0,067). Patients with CWI had the worst 5-year OS (30%) followed by Size (55%), Separate Nodule (77%), and All Others (91%). Pair-wise comparisons showed that CWI had worse OS compared to each of the three other T3 categories (p< 0,05), while Size had worse OS compared to Satellite Nodule (p=0.036). (Figure 1)

293例符合條件的患者中，51,9%為男性，平均年齡68歲。肺葉切除術的91.5% (n=268)和56% (n=164)的NSCLC是腺癌。在T3類型中，大小結節和衛星結節最常見，分別占59% (n=172)和28% (n=81)。10.6% (n=31)和14% (n=41)的患者發生局部和遠處複發，而6.8% (n=20)兩種類型的複發。多變量校正後:年齡超過65歲(p= 005)、男性(p= 007)、CWI (p= 002)、腫瘤較大(p= 0047)和不完全切除(p= 0.03)與OS惡化相關。除不完全切除(p=0,067)外，同樣的變量與更差的DFS相關(p<0,05)。CWI患者的5年OS最差(30%)，其次是大小(55%)、單獨結節(77%)和所有其他(91%)。兩兩比較顯示，CWI的OS較其他三個T3類別的OS更差(p< 0,05)，而Size較衛星結節的OS更差(p=0.036)。(圖1)

Conclusion
結論

These results show great heterogeneity within the T3N0M0 classification confirmed by the significant OS and DFS differences between T3 features. Furthermore, pair-wise comparisons showed that CWI had the worst OS when compared to all other categories. These results raise the question whether there should be a subdivision of the T3 category in the forthcoming 9^th TNM edition. Future work should focus on examining the oncologic outcomes of T3 lung cancer patients with CWI.

這些結果表明，在T3N0M0分類內存在很大的異質性，這是由T3特征之間顯著的OS和DFS差異所證實的。此外，兩兩比較顯示，與所有其他類別相比，CWI的操作係統最差。這些結果提出了一個問題，即是否應該在即將出版的第9期thTNM中對T3類別進行細分。未來的工作應集中在檢查T3肺癌患者的腫瘤預後與CWI。