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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
- Moderators:Ke-Neng Chen, Pedro Lopez De Castro
- Coordinates: 9/09/2019, 14:00 - 15:30, Toronto (1985)
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 | Author(s): Sumin Shin
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.
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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P1.18 - Treatment of Locoregional Disease - NSCLC (ID 190)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Coordinates: 9/08/2019, 09:45 - 18:00, Exhibit Hall
P1.18-24 - Neoadjuvant Therapy versus Upfront Surgery for NSCLC Patients with Clinically Suspected Subaortic or Paraaortic Lymph Nodes (ID 2568)
09:45 - 18:00 | Author(s): Sumin Shin
Subaortic lymph nodes (#LN5) and para-aortic lymph nodes (#LN6) cannot be accessed by routine mediastinoscopy and E(B)US-FNA but need additional invasive surgical staging methods such as VATS or anterior mediastinotomy. Therefore, a considerable number of patients with suspected #LN5 or #LN6 receive multimodal treatment or, upfront surgery based on imaging staging only. We investigated survival outcomes of each therapeutic strategy.Method
An institutional lung cancer database of consecutive patients between 2007 and 2016 (N=134) was reviewed retrospectively. Eligible patients had pathologically confirmed non-small cell lung cancer with clinically suspected #LN5 or #LN6 involvement by CT or PET-CT without clinical or pathological evidence of other N2 station involvement. Excluded are those with involvement of other N2 stations, unexpected N2, low grade malignancy, and prior history of cancer. Patients in group 1 received neoadjuvant therapy followed by surgery (n=68) and those in group 2 underwent upfront surgery (n=66).Result
Group 1 consisted of patients with clinically suspected (n=39, 57%), and biopsy-proven #LN5 or #LN6 (n=29, 43%) by VATS (n=19), anterior mediastinotomy (n=6), or EUS-FNA (n=4). They received preoperative chemoradiation (n=62, 91%) and the rest received chemotherapy (n=6, 9%). Nodal down-staging was occurred in 36 (53%) patients whereas persistent N2 in 32 (47%). On the contrary, group 2 consisted of patients with clinically suspected #LN5 or 6 (n=66). After surgery, 30 (45%) patients were confirmed to have pathologic N0 or N1. The rest 36 (55%) patients were confirmed pathologic N2, and 29 (81%) of them received adjuvant therapy: chemoradiation in 23, and chemotherapy in 6. Overall survival rate at 5-year (5YOS) were 50.5% in group 1 versus 58.9% in group 2 (p=0.55); recurrence-free survival at 5-year (5YRFS) was 42.2% versus 46.7% (p=0.98), respectively. In subgroup, the 5YOS were 44.6% in pathologic N2 in group 2, which were similar to persistent N2 (52.8%, p=0.6), down-staged (49.2%, p=0.89), or biopsy-proven N2 (57.8%, p=0.54) in group 1. The 5YRFS were 26.7% in pathologic N2 in group 2, which were similar to persistent N2 (30.3%, p=0.89) and biopsy-proven N2 (43.9%, p=0.15), but lower than down-staged (53%, p=0.03) in group 1.Conclusion
Upfront surgery or omission of invasive mediastinal staging for #LN5 or 6 may not compromise survival outcomes. Each therapeutic strategy is effective in terms of oncologic outcomes.