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NSCLC patients with a changing T grade after operation may represent a special subset of tumor staging

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Abstract

Background

There is consensus that postoperative adjuvant therapy is not recommended in patients with stage 1a non-small cell lung cancer (NSCLC). Meanwhile, it is still controversial whether postoperative adjuvant chemotherapy is recommended for NSCLC patients with T2aN0M0 (stage 1b). In some patients with stage 1b NSCLC without pleural invasion, tumor diameter was measured between 3 and 4 cm by preoperative imaging and less than 3 cm by postoperative pathology specimens. TNM staging in such patients is both radiologic stage 1b and pathologic stage 1a. Thoracic surgeons are often confused about whether such patients with NSCLC will require subsequent treatment and how the survival prognosis for this group of patients will be.

Methods

All data of radiographic TNM stage 1b patients who underwent radical R0 resection at the department of thoracic surgery, the First Affiliated Hospital of Soochow University between January 2013 and July 2017 were retrieved, and 208 patients were finally included in the study. Clinical data, including imaging data, pathology data, were obtained by reviewing the patients’ electronic medical records. Disease-free survival (DFS) and overall survival (OS) were obtained by telephone interview. Statistical analysis was performed using SPSS (SPSS 26.0 for windows, SPSS).

Results

A total of 208 patients were included in this study, 61 patients with T-stage migration (observation group) and 147 patients without T-stage migration (control group). There were significant statistical differences between the two groups in terms of preoperative FEV1/FVC and tumor diameter (specimens, CT and 3-dimensional measurements). Logistic regression results showed that lower FEV1/FVC and smaller CT measurements would make the patient's T stage more likely to migrate. Bland–Altman plots showed that tumor length measured by imaging was significantly higher than that measured by pathological specimens. Taking DFS as the outcome, the survival curve of the observation group was significantly better than that of the control group. Similarly, there was a significant difference in OS between the two groups.

Conclusions

For NSCLC patients whose preoperative imaging evaluation was stage 1b (tumor diameter more than 3 cm, no main bronchus, pleura, no atelectasis), the presence of lung tissue with smaller tumor diameter and/or higher air content may indicate that the postoperative pathological staging may be changed to stage 1a (tumor diameter less than 3 cm). These patients had better survival prognosis than those who did not undergo TNM stage change and were diagnosed with stage 1b non-small cell lung cancer before and after surgery.

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Data availability

The data supporting this study can be obtained from the corresponding author [Chang Li]; as the research data involve patient privacy and informed consent, the data will not be disclosed.

Abbreviations

NSCLC:

Non-small cell lung cancer

VATS:

Video-assisted thoracoscopic surgery

FEV1 :

Forced expiratory volume in one second

FVC:

Forced vital capacity

OS:

Overall survival

VC:

Vital capacity

PFTs:

Pulmonary function tests

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Acknowledgements

The authors thank all the patients who contributed data to this study.

Funding

No funding source for this study.

Author information

Author notes

  1. Kun-Peng Feng and Kai Fu have contributed equally to this work.

Authors and Affiliations

  1. Department of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Medical College of Soochow University, Suzhou, 215000, China

    Kun-Peng Feng, Kai Fu, Chun Xu, Cheng Ding, Xin-Yu Zhu, Bin Pan, Xin-Yu Jia, Jun Zhao & Chang Li

  2. Institute of Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, China

    Kun-Peng Feng, Kai Fu, Chun Xu, Cheng Ding, Xin-Yu Zhu, Bin Pan, Xin-Yu Jia, Jun Zhao & Chang Li

Authors
  1. Kun-Peng Feng
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  2. Kai Fu
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  5. Xin-Yu Zhu
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Contributions

Conception and design: K-PF, KF, JZ, CL; (II) administrative support: JZ, CL; (III) provision of study materials or patients: JZ, CL; (IV) collection and assembly of data: K-PF, KF; (V) data analysis and interpretation: K-PF, KF, CL; (VI) manuscript writing: all authors; (VII) final approval of manuscript: all authors.

Corresponding authors

Correspondence to Jun Zhao or Chang Li.

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Conflict of interests

There is no conflict of interest among the authors of this study and no objection to the selection and order of the authors.

Ethical approval and consent to participate

This study was a retrospective cohort study and was approved by the ethics committee of the First Affiliated Hospital of Soochow University (ethical approval no. 2022455). All methods were performed in accordance with the relevant guidelines and regulations. All patients participating in this study signed informed consent.

Consent to publish

All patient data collected in this study were agreed by the patients themselves, and all participants signed the informed consent form.

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Feng, KP., Fu, K., Xu, C. et al. NSCLC patients with a changing T grade after operation may represent a special subset of tumor staging. J Cancer Res Clin Oncol 149, 9991–9998 (2023). https://doi.org/10.1007/s00432-023-04925-6

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  • DOI: https://doi.org/10.1007/s00432-023-04925-6

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