1. Survival and Prognostic Factors of Resected T3N0M0 NSCLC

T3N0M0型非小细胞肺癌切除术后的生存和预后因素

Introduction
介绍

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代表非小细胞肺癌(NSCLC)的异质性组。本研究旨在比较个体T3特征的肿瘤预后。

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.

从2001年到2019年，根据8种肺癌TNM分型，共纳入293例pT3N0M0非小细胞肺癌患者。排除新辅助化疗和Pancoast肿瘤。根据T3特征将患者分为四类:(1)胸壁浸润(CWI)，(2)大小(> 5cm至≤7cm)，(3)存在卫星结节和(4)所有其他T3特征。有多个特征的患者被分组到一个单独的类别中，然后在探索特征之间的相互作用后重新分组。任何CWI都被归为1组，而不考虑其他T3特征，而Size加上除CWI以外的任何T3特征归为2组。开发了多变量回归模型来确定临床因素与肿瘤预后的关系。使用Kaplan-Meier和Cox比例风险分析估计总生存期(OS)和无病生存期(DFS)。

Results
结果

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例符合条件的患者中，51,9%为男性，平均年龄68岁。肺叶切除术的91.5% (n=268)和56% (n=164)的NSCLC是腺癌。在T3类型中，大小结节和卫星结节最常见，分别占59% (n=172)和28% (n=81)。10.6% (n=31)和14% (n=41)的患者发生局部和远处复发，而6.8% (n=20)两种类型的复发。多变量校正后:年龄超过65岁(p= 005)、男性(p= 007)、CWI (p= 002)、肿瘤较大(p= 0047)和不完全切除(p= 0.03)与OS恶化相关。除不完全切除(p=0,067)外，同样的变量与更差的DFS相关(p<0,05)。CWI患者的5年OS最差(30%)，其次是大小(55%)、单独结节(77%)和所有其他(91%)。两两比较显示，CWI的OS较其他三个T3类别的OS更差(p< 0,05)，而Size较卫星结节的OS更差(p=0.036)。(图1)

Conclusion
结论

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.

这些结果表明，在T3N0M0分类内存在很大的异质性，这是由T3特征之间显著的OS和DFS差异所证实的。此外，两两比较显示，与所有其他类别相比，CWI的操作系统最差。这些结果提出了一个问题，即是否应该在即将出版的第9期thTNM中对T3类别进行细分。未来的工作应集中在检查T3肺癌患者的肿瘤预后与CWI。