Brooks V Udelsman, Christina K Bedrosian, Eric S Kawaguchi, Li Ding, Williams D Wallace, Graeme Rosenberg, Takashi Harano, Sean Wightman, Scott Atay, Anthony W Kim, Gavitt Woodard
{"title":"生活在边缘:T期临界点2毫米范围内原发性肺癌切除术后辅助治疗的作用。","authors":"Brooks V Udelsman, Christina K Bedrosian, Eric S Kawaguchi, Li Ding, Williams D Wallace, Graeme Rosenberg, Takashi Harano, Sean Wightman, Scott Atay, Anthony W Kim, Gavitt Woodard","doi":"10.1016/j.jtcvs.2024.10.053","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the use of systemic therapy and overall survival in patients with resected non-small cell lung cancer whose pathologic tumor size was within 2 mm of a T-stage cutoff.</p><p><strong>Methods: </strong>This was retrospective cohort study using the National Cancer Database of patients who underwent resection of tumors within 2 mm of the T1c/T2a, T2a/T2b, and T2b/T3 T-stage cutoffs. Patients with nodal involvement or whose T stage was determined on the basis of pathologic features other than tumor size were excluded. A multistate model compared the primary outcomes of systemic therapy and overall survival.</p><p><strong>Results: </strong>From the National Cancer Database, 18,490 patients were identified: 9966 at the T1c/T2a cutoff, 5593 at the T2a/T2b cutoff, and 2931 at the T2b/T3 cutoff. Peaks in tumor size distribution occurred at 5-mm intervals. On the basis of an expected normalized curve, 2050 patients (11.1%) may have been understaged. Use of systemic therapy was greater among patients with larger tumors at the T1c/T2a cutoff (7.1% vs 8.9%; P < .001), the T2a/T2b cutoff (20.0% vs 25.5%; P < .001), and the T2b/T3 cutoff (31.2% vs 41.8%; P < .001). In a multistate model, mortality was greater above the T1c/T2a cutoff (hazard ratio [HR], 1.10; P = .01), T2a/T2b cutoff (HR, 1.17; P < .01), and T2b/T3 cutoff (HR, 1.13; P = .03). In patients who received systemic therapy, this trend was eliminated (HR, 1.24; P = .14, HR, 0.79; P = .07, and HR, 1.23; P = .09, respectively).</p><p><strong>Conclusions: </strong>Rounding of tumor size for pathologic staging is common. Although seemingly trivial, rounding may downstage patients and is associated with decreased rates of adjuvant therapy use and potentially worse overall survival.</p>","PeriodicalId":49975,"journal":{"name":"Journal of Thoracic and Cardiovascular Surgery","volume":" ","pages":""},"PeriodicalIF":4.9000,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Living on the edge: Role of adjuvant therapy after resection of primary lung cancer within 2 millimeters of a T-stage cutoff.\",\"authors\":\"Brooks V Udelsman, Christina K Bedrosian, Eric S Kawaguchi, Li Ding, Williams D Wallace, Graeme Rosenberg, Takashi Harano, Sean Wightman, Scott Atay, Anthony W Kim, Gavitt Woodard\",\"doi\":\"10.1016/j.jtcvs.2024.10.053\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To evaluate the use of systemic therapy and overall survival in patients with resected non-small cell lung cancer whose pathologic tumor size was within 2 mm of a T-stage cutoff.</p><p><strong>Methods: </strong>This was retrospective cohort study using the National Cancer Database of patients who underwent resection of tumors within 2 mm of the T1c/T2a, T2a/T2b, and T2b/T3 T-stage cutoffs. Patients with nodal involvement or whose T stage was determined on the basis of pathologic features other than tumor size were excluded. A multistate model compared the primary outcomes of systemic therapy and overall survival.</p><p><strong>Results: </strong>From the National Cancer Database, 18,490 patients were identified: 9966 at the T1c/T2a cutoff, 5593 at the T2a/T2b cutoff, and 2931 at the T2b/T3 cutoff. Peaks in tumor size distribution occurred at 5-mm intervals. On the basis of an expected normalized curve, 2050 patients (11.1%) may have been understaged. Use of systemic therapy was greater among patients with larger tumors at the T1c/T2a cutoff (7.1% vs 8.9%; P < .001), the T2a/T2b cutoff (20.0% vs 25.5%; P < .001), and the T2b/T3 cutoff (31.2% vs 41.8%; P < .001). In a multistate model, mortality was greater above the T1c/T2a cutoff (hazard ratio [HR], 1.10; P = .01), T2a/T2b cutoff (HR, 1.17; P < .01), and T2b/T3 cutoff (HR, 1.13; P = .03). In patients who received systemic therapy, this trend was eliminated (HR, 1.24; P = .14, HR, 0.79; P = .07, and HR, 1.23; P = .09, respectively).</p><p><strong>Conclusions: </strong>Rounding of tumor size for pathologic staging is common. Although seemingly trivial, rounding may downstage patients and is associated with decreased rates of adjuvant therapy use and potentially worse overall survival.</p>\",\"PeriodicalId\":49975,\"journal\":{\"name\":\"Journal of Thoracic and Cardiovascular Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-11-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Thoracic and Cardiovascular Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jtcvs.2024.10.053\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Thoracic and Cardiovascular Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtcvs.2024.10.053","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Living on the edge: Role of adjuvant therapy after resection of primary lung cancer within 2 millimeters of a T-stage cutoff.
Objectives: To evaluate the use of systemic therapy and overall survival in patients with resected non-small cell lung cancer whose pathologic tumor size was within 2 mm of a T-stage cutoff.
Methods: This was retrospective cohort study using the National Cancer Database of patients who underwent resection of tumors within 2 mm of the T1c/T2a, T2a/T2b, and T2b/T3 T-stage cutoffs. Patients with nodal involvement or whose T stage was determined on the basis of pathologic features other than tumor size were excluded. A multistate model compared the primary outcomes of systemic therapy and overall survival.
Results: From the National Cancer Database, 18,490 patients were identified: 9966 at the T1c/T2a cutoff, 5593 at the T2a/T2b cutoff, and 2931 at the T2b/T3 cutoff. Peaks in tumor size distribution occurred at 5-mm intervals. On the basis of an expected normalized curve, 2050 patients (11.1%) may have been understaged. Use of systemic therapy was greater among patients with larger tumors at the T1c/T2a cutoff (7.1% vs 8.9%; P < .001), the T2a/T2b cutoff (20.0% vs 25.5%; P < .001), and the T2b/T3 cutoff (31.2% vs 41.8%; P < .001). In a multistate model, mortality was greater above the T1c/T2a cutoff (hazard ratio [HR], 1.10; P = .01), T2a/T2b cutoff (HR, 1.17; P < .01), and T2b/T3 cutoff (HR, 1.13; P = .03). In patients who received systemic therapy, this trend was eliminated (HR, 1.24; P = .14, HR, 0.79; P = .07, and HR, 1.23; P = .09, respectively).
Conclusions: Rounding of tumor size for pathologic staging is common. Although seemingly trivial, rounding may downstage patients and is associated with decreased rates of adjuvant therapy use and potentially worse overall survival.
期刊介绍:
The Journal of Thoracic and Cardiovascular Surgery presents original, peer-reviewed articles on diseases of the heart, great vessels, lungs and thorax with emphasis on surgical interventions. An official publication of The American Association for Thoracic Surgery and The Western Thoracic Surgical Association, the Journal focuses on techniques and developments in acquired cardiac surgery, congenital cardiac repair, thoracic procedures, heart and lung transplantation, mechanical circulatory support and other procedures.