{"title":"Prognostic Value of Preoperative N Subcategories in Patients with Stage IIIA N2 Non-Small Cell Lung Cancer.","authors":"Na Eun Oh, Jooae Choe, Jae Kwang Yun, Wonjun Ji, Seonok Kim, Eun Jin Chae, Sang Min Lee, Joon Beom Seo","doi":"10.1148/ryct.230347","DOIUrl":null,"url":null,"abstract":"<p><p>Purpose To evaluate the preoperative risk factors in patients with pathologic IIIA N2 non-small cell lung cancer (NSCLC) who underwent upfront surgery and to evaluate the prognostic value of new N subcategories. Materials and Methods Patients with pathologic stage IIIA N2 NSCLC who underwent upfront surgery in a single tertiary center from January 2015 to April 2021 were retrospectively reviewed. Each patient's clinical N (cN) was assigned to one of six subcategories (cN0, cN1a, cN1b, cN2a1, cN2a2, and cN2b) based on recently proposed N descriptors. Cox regression analysis was used to identify the significant prognostic factors for recurrence-free survival (RFS) and overall survival (OS). Results A total of 366 patients (mean age ± SD, 62.0 years ± 10.1; 202 male patients [55%]) were analyzed. The recurrence rate was 55% (203 of 366 patients) over a median follow-up of 37.3 months. Multivariable analysis demonstrated that cN (hazard ratios [HRs] for cN1 and cN2b compared with cN0, 1.66 [95% CI: 1.11, 2.48] and 2.11 [95% CI: 1.32, 3.38], respectively) and maximum lymph node (LN) size at N1 station (≥12 mm; HR, 1.62 [95% CI: 1.15, 2.29]), in addition to clinical T category (HR, 1.51 [95% CI: 1.14, 1.99]), were independent prognostic factors for RFS. For OS, clinical N subcategories (cN1, cN2a2, and cN2b vs cN0; HRs, 1.91 [95% CI: 1.11, 3.27], 1.89 [95% CI: 1.13, 2.18], and 2.02 [95% CI: 1.07, 3.80], respectively) and LN size at N1 station (HR, 1.75 [95% CI: 1.12, 2.71]) were independent prognostic factors. For clinical N1, OS was further stratified according to LN size (log-rank test, <i>P</i> < .001). Conclusion Assessing the proposed N subcategories by reporting single versus multistation involvement of N2 disease and maximum size of metastatic LN, reflecting metastatic burden, at preoperative CT may offer useful prognostic information for planning optimal treatment strategies. <b>Keywords:</b> CT, Lung, Staging, Non-Small Cell Lung Cancer <i>Supplemental material is available for this article</i>. ©RSNA, 2024.</p>","PeriodicalId":21168,"journal":{"name":"Radiology. Cardiothoracic imaging","volume":null,"pages":null},"PeriodicalIF":3.8000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369650/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Radiology. Cardiothoracic imaging","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1148/ryct.230347","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose To evaluate the preoperative risk factors in patients with pathologic IIIA N2 non-small cell lung cancer (NSCLC) who underwent upfront surgery and to evaluate the prognostic value of new N subcategories. Materials and Methods Patients with pathologic stage IIIA N2 NSCLC who underwent upfront surgery in a single tertiary center from January 2015 to April 2021 were retrospectively reviewed. Each patient's clinical N (cN) was assigned to one of six subcategories (cN0, cN1a, cN1b, cN2a1, cN2a2, and cN2b) based on recently proposed N descriptors. Cox regression analysis was used to identify the significant prognostic factors for recurrence-free survival (RFS) and overall survival (OS). Results A total of 366 patients (mean age ± SD, 62.0 years ± 10.1; 202 male patients [55%]) were analyzed. The recurrence rate was 55% (203 of 366 patients) over a median follow-up of 37.3 months. Multivariable analysis demonstrated that cN (hazard ratios [HRs] for cN1 and cN2b compared with cN0, 1.66 [95% CI: 1.11, 2.48] and 2.11 [95% CI: 1.32, 3.38], respectively) and maximum lymph node (LN) size at N1 station (≥12 mm; HR, 1.62 [95% CI: 1.15, 2.29]), in addition to clinical T category (HR, 1.51 [95% CI: 1.14, 1.99]), were independent prognostic factors for RFS. For OS, clinical N subcategories (cN1, cN2a2, and cN2b vs cN0; HRs, 1.91 [95% CI: 1.11, 3.27], 1.89 [95% CI: 1.13, 2.18], and 2.02 [95% CI: 1.07, 3.80], respectively) and LN size at N1 station (HR, 1.75 [95% CI: 1.12, 2.71]) were independent prognostic factors. For clinical N1, OS was further stratified according to LN size (log-rank test, P < .001). Conclusion Assessing the proposed N subcategories by reporting single versus multistation involvement of N2 disease and maximum size of metastatic LN, reflecting metastatic burden, at preoperative CT may offer useful prognostic information for planning optimal treatment strategies. Keywords: CT, Lung, Staging, Non-Small Cell Lung Cancer Supplemental material is available for this article. ©RSNA, 2024.
IIIA N2 期非小细胞肺癌患者术前 N 子类别的预后价值
目的 评估接受前期手术的病理分期为 IIIA N2 非小细胞肺癌(NSCLC)患者的术前风险因素,并评估新 N 亚类的预后价值。材料与方法 对 2015 年 1 月至 2021 年 4 月期间在一家三级中心接受前期手术的病理 IIIA N2 期 NSCLC 患者进行了回顾性研究。根据最近提出的N描述符,将每位患者的临床N(cN)归入六个子类别(cN0、cN1a、cN1b、cN2a1、cN2a2和cN2b)之一。采用 Cox 回归分析确定无复发生存率(RFS)和总生存率(OS)的重要预后因素。结果 共分析了 366 例患者(平均年龄 ± SD,62.0 岁 ± 10.1;男性患者 202 例 [55%])。中位随访时间为 37.3 个月,复发率为 55%(366 例患者中有 203 例复发)。多变量分析表明,cN(与 cN0 相比,cN1 和 cN2b 的危险比 [HRs] 分别为 1.66 [95% CI: 1.11, 2.48] 和 2.11 [95% CI: 1.32, 3.38])和N1站最大淋巴结(LN)大小(≥12 mm; HR, 1.62 [95% CI: 1.15, 2.29])是RFS的独立预后因素,此外,临床T分类(HR, 1.51 [95% CI: 1.14, 1.99])也是RFS的独立预后因素。对于 OS,临床 N 亚类(cN1、cN2a2 和 cN2b vs cN0;HRs 分别为 1.91 [95% CI: 1.11, 3.27]、1.89 [95% CI: 1.13, 2.18] 和 2.02 [95% CI: 1.07, 3.80])和 N1 站的 LN 大小(HRs 为 1.75 [95% CI: 1.12, 2.71])是独立的预后因素。对于临床 N1,OS 根据 LN 大小进一步分层(对数秩检验,P < .001)。结论 在术前 CT 上报告 N2 病变的单个或多个分区受累情况以及反映转移负荷的转移 LN 的最大大小来评估所提出的 N 亚类,可为规划最佳治疗策略提供有用的预后信息。关键词: CTCT、肺、分期、非小细胞肺癌 本文有补充材料。©RSNA, 2024.
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