한빛사 논문
Lee, Junghee MD, PhD*; Lee, Jin MPH†,‡; Hong, Yun Soo MD, MHS§; Lee, Genehee MSN†,¶; Kang, Danbee PhD†,‡; Yun, Jeonghee MD*; Jeon, Yeong Jeong MD*; Shin, Sumin MD*; Cho, Jong Ho MD, PhD*; Choi, Yong Soo MD, PhD*; Kim, Jhingook MD*; Zo, Jae Ill MD, PhD*; Shim, Young Mog MD, PhD*,¶; Guallar, Eliseo DrPh§; Cho, Juhee MA, PhD†,‡,§,¶; Kim, Hong Kwan MD, PhD*,¶
*Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
†Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, Seoul, Korea
‡Centre for Clinical Epidemiology, Sungkyunkwan University, Samsung Medical Center, Seoul, Korea
§Departments of Epidemiology and Medicine, and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public Health. Baltimore, Maryland, USA
¶Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Korea.
Junghee Lee and Jin Lee contributed equally to this study as first authors.
Juhee Cho and Hong Kwan Kim contributed equally to this study as corresponding authors.
Abstract
Objective:
To validate the International Association for the Study of Lung Cancer (IASLC) residual tumor classification in patients with stage III-N2 non-small cell lung cancer (NSCLC) undergoing neoadjuvant concurrent chemoradiotherapy (nCCRT) followed by surgery.
Background:
As adequate nodal assessment is crucial for determining prognosis in patients with clinical N2 NSCLC undergoing nCCRT followed by surgery, the new classification may have better prognostic implications.
Methods:
Using a registry for thoracic cancer surgery at a tertiary hospital in Seoul, Korea, between 2003 and 2019, we analyzed 910 patients with stage III-N2 NSCLC who underwent nCCRT followed by surgery. We classified resections using IASLC criteria: complete (R0), uncertain (R[un]), and incomplete resection (R1/R2). Recurrence and mortality were compared using adjusted subdistribution hazard model and Cox-proportional hazards model, respectively.
Results:
Of the 96.3%(n = 876) patients who were R0 by Union for International Cancer Control (UICC) criteria, 34.5%(n = 302) remained R0 by IASLC criteria and 37.6%(n = 329) and 28%(n = 245) migrated to R(un) and R1, respectively. Most of the migration from UICC-R0 to IASLC-R(un) and IASLC-R1/R2 occurred due to inadequate nodal assessment (85.5%) and extracapsular nodal extension (77.6%), respectively. Compared to R0, the adjusted hazard ratios in R(un) and R1/R2 were 1.20 (95% confidence interval, 0.94–1.52), 1.50 (1.17–1.52) (p for trend = 0.001) for recurrence and 1.18 (0.93–1.51) and 1.51 (1.17–1.96) for death (p for trend = 0.002).
Conclusions:
The IASLC R classification has prognostic relevance in patients with stage III-N2 NSCLC undergoing nCCRT followed by surgery. The IASLC classification will improve the thoroughness of intraoperative nodal assessment and the completeness of resection.
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