What Is the Accuracy of Clinical Staging for Stage III-Single-station N2 NSCLC? A Multi-Centre UK Study

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Abstract

Introduction

Single-station N2 (ssN2) versus multi-station N2 has been used as a selection criterion for treatment recommendations between surgical versus non-surgical multimodality treatment in stage III-N2 NSCLC. We hypothesized that clinical staging would be susceptible to upstaging on pathologic staging and, therefore, challenge this practice.

Methods

A retrospective study of prospectively collected routine clinical data for patients with stage III-N2 NSCLC that had completed computed tomography (CT), positron emission tomography (PET), and staging endobronchial ultrasound (EBUS) and had been confirmed clinical stage III-ssN2 at multidisciplinary team discussion and went on to complete surgical resection as the first treatment to provide pathologic staging. The study was completed in two cohorts (A) across a single cancer alliance in England (Greater Manchester) January 1, 2015 to December 31, 2018 and (B) across five United Kingdom centers to validate the findings in part A January 1, 2016 to December 31, 2020.

Results

A total of 115 patients met the inclusion criteria across cohort A (56 patients) and cohort B (59 patients) across 15 United Kingdom hospitals. The proportion of cases in which clinical stage III-ssN2 was upstaged to pathologic stage III-multi-station N2 was 34% (19 of 56) in cohort A, 32% in cohort B (19 of 59), and 33% across the combined study cohort (38 of 115). Most patients had a single radiologically abnormal lymph node on CT and PET (88%, 105 of 115). In the majority, the reasons for missed N2 disease on staging EBUS were due to inaccessible (stations 5, 6, 8, 9) N2 nodes at EBUS (34%, 13 of 38) and accessible lymph nodes not sampled during staging EBUS as not meeting sampling threshold (40%, 15 of 38) rather than false-negative sampling during EBUS (26%, 10 of 38).

Conclusions

During multidisciplinary team discussions, clinicians must be aware that one-third of patients with stage III-ssN2 on the basis of CT, PET, and staging EBUS do not truly have ssN2 and this questions the use of this criterion to define treatment recommendations.

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III 期单发 N2 NSCLC 临床分期的准确性如何?英国一项多中心研究
导言单站 N2(ssN2)与多站 N2 一直被用作 III-N2 期 NSCLC 手术与非手术多模式治疗推荐的选择标准。我们假设临床分期容易受到病理分期上调的影响,因此对这一做法提出质疑。方法对前瞻性收集的常规临床数据进行回顾性研究,研究对象为已完成计算机断层扫描(CT)、正电子发射断层扫描(PET)和分期支气管内超声检查(EBUS),经多学科团队讨论确认为临床 III-ssN2 期,并继续完成手术切除作为首次治疗以提供病理分期的 III-N2 期 NSCLC 患者。该研究在两个队列中完成:(A) 2015 年 1 月 1 日至 2018 年 12 月 31 日在英格兰(大曼彻斯特地区)的一个癌症联盟中完成;(B) 2016 年 1 月 1 日至 2020 年 12 月 31 日在英国的五个中心完成,以验证 A 部分的研究结果。结果 在英国 15 家医院的队列 A(56 例患者)和队列 B(59 例患者)中,共有 115 例患者符合纳入标准。临床III期ssN2升为病理III期多站N2的病例比例在队列A中为34%(56例中的19例),在队列B中为32%(59例中的19例),在合并研究队列中为33%(115例中的38例)。大多数患者在 CT 和 PET 上只有一个淋巴结出现放射学异常(88%,115 人中有 105 人)。大多数患者在 EBUS 分期检查中漏诊 N2 病变的原因是 EBUS 检查时无法触及(第 5、6、8、9 站)N2 结(34%,38 例中的 13 例),以及 EBUS 分期检查时因未达到取样阈值而未取样的可触及淋巴结(40%,38 例中的 15 例),而不是 EBUS 检查时的假阴性取样(26%,38 例中的 10 例)。结论在多学科团队讨论时,临床医生必须意识到,根据 CT、PET 和分期 EBUS 诊断为 III-ssN2 期的患者中,有三分之一并非真正的 ssN2 期,这就对使用这一标准来确定治疗建议提出了质疑。
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CiteScore
4.20
自引率
0.00%
发文量
145
审稿时长
19 weeks
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