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Byung Jo Park



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    OA10 - Sophisticated TNM Staging System for Lung Cancer (ID 136)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Staging
    • Presentations: 1
    • Now Available
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      OA10.02 - Recommended Change for N Descriptor Proposed by the IASLC: A Validation Study from a Single-Center Experience (Now Available) (ID 2117)

      14:00 - 15:30  |  Presenting Author(s): Byung Jo Park

      • Abstract
      • Presentation
      • Slides

      Background

      The International Association for the Study of Lung Cancer (IASLC) recently proposed changes for N descriptor based on the location and number of involved lymph node stations. The aim of our study was to evaluate the discriminatory ability and prognostic performance of the proposed N descriptor in a large independent non-small cell lung cancer (NSCLC) cohort.

      Method

      IASLC proposals include: a classification of N descriptor by combining the present nodal categories and number of involved lymph node stations into: N0; single-station N1 (N1a); multiple-stations N1 (N1b); single-station N2 without N1 involvement (N2a1); single-station N2 with N1 involvement (N2a2); multiple-stations N2 (N2b) and N3. A total of 1128 patients who underwent major pulmonary resection for pathologic N1 or N2 NSCLC between 2004 and 2014 were analyzed in this study. survival analysis was performed using Cox proportional hazard model to assess the prognostic significance of the N descriptor.

      Result

      From 2004 to 2014, 7437 patients were operated on for non-small-cell lung carcinoma (NSCLC). Among those, patients who underwent preoperative treatment for stage IIIA-N2 NSCLC were excluded (N=-698, 9.4%). Patients who were confirmed as pathologic N1 (N=676) or N2 (N=452) after surgery were included in this study. Invasive mediastinal staging (EBUS or mediastinoscopy) was done in 614 patients (54.4%). After surgery, adjuvant treatments were performed in 901 patients (81.7%). The mean total number of dissected lymph node was 25.7 ± 11.0, and the mean number of involved (metastatic) lymph node was 3.0 ± 3.2. The 5-year overall survival rate was 64.7 % in N1a, 57.1% in N1b, 68.0% in N2a1, 50.1% in N2a2, and 46.7% in N2b. Based on our study about the overall survival and recurrence-free survival, N2a1 is not clearly divided into N1a and N1b is not clearly divided with N2a2.

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      Conclusion

      Based on the proposed N stage classification by combining the LN station number with the proposed anatomic location in IASLC, all 5 groups were not clearly identified. According to our analysis, it would be better to classify similar prognostic group as 3 or 4 group to divide the group. The new N classifications should be considered for future revisions of TNM staging system for lung cancer.

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