T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer

Qiuyuan Li, Peng Zhang, Yi Wang, Dan Liu, Lei Luo, Robert B Diasio, Ping Yang, Gening Jiang

Research output: Contribution to journalArticle

Abstract

OBJECTIVES T4N0-1 non-small-cell lung cancer (NSCLC) was historically considered curable but now includes tumours of size >7 cm according to the 8th edition tumour, node and metastasis (TNM) staging. This study was set out to evaluate the role of surgery and predictors of long-term survival after surgery in this renewed group of patients. METHODS Patients, with clinical T4N0-2M0 NSCLC diagnosed in 2010-2013, in the National Cancer Database were queried. A Cox regression analysis was applied to investigate independent predictors of survival in 1588 N0-1 surgical cases. For previous T3 cases, the efficacy of treatment including and not including surgery was compared after propensity score matching by age, gender, race, facility type, comorbidity, laterality, clinical N stage, histology and tumour grade. RESULTS In newly defined T4N0-1 NSCLC patients undergoing surgery, age, gender, comorbidity, nodal status, resection margin, tumour grade, chemotherapy and extension-size group were shown to be independent predictors of survival. In particular, patients with only T4 extension showed better survival than patients with tumour size >7 cm only [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.62-0.92, P = 0.016]. In the latter group, surgical treatment was associated with better survival than non-surgical treatment after matching (HR 0.45, 95% CI 0.42-0.48, P < 0.001). CONCLUSIONS In the newly defined T4 NSCLC, tumour size >7 cm is a descriptor that is more predictive of worse survival than local extension alone for patients whose treatment included surgery. For T4-extended, N0-1 NSCLC with a tumour size ≤7 cm, surgery might be associated with favourable long-term outcomes and should be further encouraged as a treatment option.

Original languageEnglish (US)
Pages (from-to)682-690
Number of pages9
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume55
Issue number4
DOIs
StatePublished - Apr 1 2019

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Non-Small Cell Lung Carcinoma
Survival
Neoplasms
Comorbidity
Confidence Intervals
Propensity Score
Therapeutics
Histology
Regression Analysis
Databases
Neoplasm Metastasis
Drug Therapy

Keywords

  • Locally advanced
  • National Cancer Database
  • Non-small-cell lung cancer
  • Prognosis
  • Surgery
  • Tumour size

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer. / Li, Qiuyuan; Zhang, Peng; Wang, Yi; Liu, Dan; Luo, Lei; Diasio, Robert B; Yang, Ping; Jiang, Gening.

In: European Journal of Cardio-Thoracic Surgery, Vol. 55, No. 4, 01.04.2019, p. 682-690.

Research output: Contribution to journalArticle

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title = "T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer",
abstract = "OBJECTIVES T4N0-1 non-small-cell lung cancer (NSCLC) was historically considered curable but now includes tumours of size >7 cm according to the 8th edition tumour, node and metastasis (TNM) staging. This study was set out to evaluate the role of surgery and predictors of long-term survival after surgery in this renewed group of patients. METHODS Patients, with clinical T4N0-2M0 NSCLC diagnosed in 2010-2013, in the National Cancer Database were queried. A Cox regression analysis was applied to investigate independent predictors of survival in 1588 N0-1 surgical cases. For previous T3 cases, the efficacy of treatment including and not including surgery was compared after propensity score matching by age, gender, race, facility type, comorbidity, laterality, clinical N stage, histology and tumour grade. RESULTS In newly defined T4N0-1 NSCLC patients undergoing surgery, age, gender, comorbidity, nodal status, resection margin, tumour grade, chemotherapy and extension-size group were shown to be independent predictors of survival. In particular, patients with only T4 extension showed better survival than patients with tumour size >7 cm only [hazard ratio (HR) 0.75, 95{\%} confidence interval (CI) 0.62-0.92, P = 0.016]. In the latter group, surgical treatment was associated with better survival than non-surgical treatment after matching (HR 0.45, 95{\%} CI 0.42-0.48, P < 0.001). CONCLUSIONS In the newly defined T4 NSCLC, tumour size >7 cm is a descriptor that is more predictive of worse survival than local extension alone for patients whose treatment included surgery. For T4-extended, N0-1 NSCLC with a tumour size ≤7 cm, surgery might be associated with favourable long-term outcomes and should be further encouraged as a treatment option.",
keywords = "Locally advanced, National Cancer Database, Non-small-cell lung cancer, Prognosis, Surgery, Tumour size",
author = "Qiuyuan Li and Peng Zhang and Yi Wang and Dan Liu and Lei Luo and Diasio, {Robert B} and Ping Yang and Gening Jiang",
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T1 - T4 extension alone is more predictive of better survival than a tumour size >7 cm for resected T4N0-1M0 non-small-cell lung cancer

AU - Li, Qiuyuan

AU - Zhang, Peng

AU - Wang, Yi

AU - Liu, Dan

AU - Luo, Lei

AU - Diasio, Robert B

AU - Yang, Ping

AU - Jiang, Gening

PY - 2019/4/1

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N2 - OBJECTIVES T4N0-1 non-small-cell lung cancer (NSCLC) was historically considered curable but now includes tumours of size >7 cm according to the 8th edition tumour, node and metastasis (TNM) staging. This study was set out to evaluate the role of surgery and predictors of long-term survival after surgery in this renewed group of patients. METHODS Patients, with clinical T4N0-2M0 NSCLC diagnosed in 2010-2013, in the National Cancer Database were queried. A Cox regression analysis was applied to investigate independent predictors of survival in 1588 N0-1 surgical cases. For previous T3 cases, the efficacy of treatment including and not including surgery was compared after propensity score matching by age, gender, race, facility type, comorbidity, laterality, clinical N stage, histology and tumour grade. RESULTS In newly defined T4N0-1 NSCLC patients undergoing surgery, age, gender, comorbidity, nodal status, resection margin, tumour grade, chemotherapy and extension-size group were shown to be independent predictors of survival. In particular, patients with only T4 extension showed better survival than patients with tumour size >7 cm only [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.62-0.92, P = 0.016]. In the latter group, surgical treatment was associated with better survival than non-surgical treatment after matching (HR 0.45, 95% CI 0.42-0.48, P < 0.001). CONCLUSIONS In the newly defined T4 NSCLC, tumour size >7 cm is a descriptor that is more predictive of worse survival than local extension alone for patients whose treatment included surgery. For T4-extended, N0-1 NSCLC with a tumour size ≤7 cm, surgery might be associated with favourable long-term outcomes and should be further encouraged as a treatment option.

AB - OBJECTIVES T4N0-1 non-small-cell lung cancer (NSCLC) was historically considered curable but now includes tumours of size >7 cm according to the 8th edition tumour, node and metastasis (TNM) staging. This study was set out to evaluate the role of surgery and predictors of long-term survival after surgery in this renewed group of patients. METHODS Patients, with clinical T4N0-2M0 NSCLC diagnosed in 2010-2013, in the National Cancer Database were queried. A Cox regression analysis was applied to investigate independent predictors of survival in 1588 N0-1 surgical cases. For previous T3 cases, the efficacy of treatment including and not including surgery was compared after propensity score matching by age, gender, race, facility type, comorbidity, laterality, clinical N stage, histology and tumour grade. RESULTS In newly defined T4N0-1 NSCLC patients undergoing surgery, age, gender, comorbidity, nodal status, resection margin, tumour grade, chemotherapy and extension-size group were shown to be independent predictors of survival. In particular, patients with only T4 extension showed better survival than patients with tumour size >7 cm only [hazard ratio (HR) 0.75, 95% confidence interval (CI) 0.62-0.92, P = 0.016]. In the latter group, surgical treatment was associated with better survival than non-surgical treatment after matching (HR 0.45, 95% CI 0.42-0.48, P < 0.001). CONCLUSIONS In the newly defined T4 NSCLC, tumour size >7 cm is a descriptor that is more predictive of worse survival than local extension alone for patients whose treatment included surgery. For T4-extended, N0-1 NSCLC with a tumour size ≤7 cm, surgery might be associated with favourable long-term outcomes and should be further encouraged as a treatment option.

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KW - Prognosis

KW - Surgery

KW - Tumour size

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