Beyond Margin Status: Population-Based Validation of the Proposed International Association for the Study of Lung Cancer Residual Tumor Classification Recategorization
Beyond Margin Status: Population-Based Validation of the Proposed International Association for the Study of Lung Cancer Residual Tumor Classification Recategorization
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DOI：
10.1016/j.jtho.2019.11.009
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发表时间：
2020-03-01
影响因子：
20.4
通讯作者：
Smeltzer, Matthew P.
中科院分区：
文献类型：
--
作者：
Osarogiagbon, Raymond U.;Faris, Nicholas R.;Smeltzer, Matthew P.
简介：国际肺癌研究协会（IASLC）建议对切除的NSCLC的残留肿瘤（R）分类进行重新分类，这需要验证。方法：使用美国2009年至2019年基于人群的多机构NSCLC切除队列，我们根据国际癌症控制联盟（UICC）结果：3361例手术中，UICC标准R 0占95.3%，R1占4.3%，R2占0.4%;根据IASLC标准，33.3%为R 0，60.8%为R-不确定，5.8%为R1/2; 2044例患者（63.8%）从UICC R 0迁移至IASLC R-不确定。对于IASLC R 0、R-不确定和R1或R2切除的患者，中位生存期分别为69（95%置信区间[CI]：64-77）和25（95% CI：18-36）个月。未能达到淋巴结清扫标准导致98%的转移到R-不确定，转移到最高纵隔淋巴结站，5.8%。与R 0相比，有纵隔淋巴结、无纵隔淋巴结和无淋巴结的R-不确定性切除术的校正风险比分别为1.28（95% CI：1.10-1.48）、1.47（95% CI：1.24-1.74）和1.74（95% CI：1.37-2.21），表明淋巴结R-不确定性与生存率之间存在剂量-反应关系。考虑到纵隔淋巴结受累，最高纵隔淋巴结受累不是独立预后。不完整的切除变量是一致的预后。结论：建议的R分类重新分类变量的预后，除了最高纵隔淋巴结站参与。应考虑根据节点质量缺陷的严重程度对R-不确定性进行进一步分类。(C)2019年国际肺癌研究协会。爱思唯尔公司出版All rights reserved.
Introduction: The International Association for the Study of Lung Cancer's (IASLC's) proposal to recategorize the residual tumor (R) classification for resected NSCLC needs validation.Methods: Using a 2009 to 2019 population-based multi-institutional NSCLC resection cohort from the United States, we classified resections by Union for International Cancer Control (UICC) and IASLC R criteria and compared the distribution of R classification variables and their survival associations.Results: Of 3361 resections, 95.3% were R0, 4.3% were R1, and 0.4% were R2 by UICC criteria; 33.3% were R0, 60.8% were R-uncertain, and 5.8% were R1/2 by IASLC criteria; 2044 patients (63.8%) migrated from UICC R0 to IASLC R-uncertain. Median survival was not reached, 69 (95% confidence interval [CI]: 64-77), and 25 (95% CI: 18-36) months, respectively, for patients with IASLC R0, R-uncertain, and R1 or R2 resections. Failure to achieve nodal dissection criteria caused 98% of migration to R-uncertainty, metastasis to the highest mediastinal node station, 5.8%. Compared with R0, R-uncertain resections with mediastinal nodes, no mediastinal nodes, and no nodes had adjusted hazard ratios of 1.28 (95% CI: 1.10-1.48), 1.47 (95% CI: 1.24-1.74), and 1.74 (95% CI: 1.37-2.21), respectively, suggesting a dose-response relationship between nodal R-uncertainty and survival. Accounting for mediastinal nodal involvement, the highest mediastinal station involvement was not independently prognostic. The incomplete resection variables were uniformly prognostic.Conclusions: The proposed R classification recategorization variables were mostly prognostic, except the highest mediastinal nodal station involvement. Further categorization of R-uncertainty by severity of nodal quality deficit should be considered. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.