John G Edwards1, Kari Chansky2, Paul Van Schil3, Andrew G Nicholson4, Souheil Boubia5, Elisabeth Brambilla6, Jessica Donington7, Françoise Galateau-Sallé8, Hans Hoffmann9, Maurizio Infante10, Mirella Marino11, Edith M Marom12, Jun Nakajima13, Marcin Ostrowski14, William D Travis15, Ming-Sound Tsao16, Yasushi Yatabe17, Dorothy J Giroux2, Lynn Shemanski2, John Crowley2, Marc Krasnik18, Hisao Asamura19, Ramón Rami-Porta20. 1. Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals National Health Service Foundation Trust, Northern General Hospital, Sheffield, United Kingdom. Electronic address: john.edwards3@nhs.net. 2. Cancer Research And Biostatistics, Seattle, Washington. 3. Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium. 4. Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and National Heart and Lung Division, Imperial College, London, United Kingdom. 5. Department of Thoracic Surgery, University Hospital, Ibn Rochd, Casablanca, Morocco. 6. Department of Pathology, Centre Hospitalier Universitaire, Grenoble, France, University of Grenoble Alpes, Grenoble, France. 7. Section of Thoracic Surgery, The University of Chicago Medicine and Biological Sciences, Chicago, Illinois. 8. Department of Pathology, Centre Hospitalier Universitaire, Caen, France. 9. Department of Thoracic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 10. Department of Thoracic Surgery, Ospedale Borgo Trento, Verona, Italy. 11. Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy. 12. Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel. 13. Department of Thoracic Surgery, The University of Tokyo, Tokyo, Japan. 14. Department of Thoracic Surgery, Medical University of Gdańsk, Gdańsk, Poland. 15. Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York. 16. Department of Pathology, The Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 17. Department of Pathology, Aichi Cancer Center Hospital, Nagoya, Japan. 18. Department of Thoracic Surgery, Gentofte University Hospital, Copenhagen, Denmark. 19. Division of Thoracic Surgery, Keio School of Medicine, Tokyo, Japan. 20. Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
Abstract
OBJECTIVE: Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un). METHODS: A total of 14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: whether fewer than three N2 stations were explored, lobe-specific nodal dissection, extracapsular extension, highest lymph node station status, carcinoma in situ at the bronchial resection margin, and pleural lavage cytologic examination result. Revised categories of R0, R(un), R1, and R2 were tested for survival impact. RESULTS: In all, 14,293 cases were R0, 263 were R1, and 156 were R2 (median survivals not reached, 33 months, and 29 months, respectively). R status correlated with T and N categories. A total of 9290 cases (63%) had three or more N2 stations explored and 6641 cases (45%) had lobe-specific nodal dissection, correlated with increasing pN2. Extracapsular extension was present in 62 of 364 cases with available data (17%). The highest station was positive in 942 cases (6.4%). The pleural lavage cytologic examination result was positive in 59 of 1705 cases (3.5%): 13 had carcinoma in situ at the bronchial resection margin. After reassignment because of inadequate nodal staging in 56% of cases, 6070 cases were R0, 8185 were R(un), 301 were R1, and 156 were R2. In node-positive cases, the median survival times were 70, 50, and 30 months for R0, R(un) (p < 0.0001), and R1 (p < 0.001), respectively, with no significant difference between R0 and R(un) in pN0 cases. CONCLUSIONS: R descriptors have prognostic relevance, with R(un) survival stratifying between R0 and R1. Therefore, a detailed evaluation of R factor is of particular importance in the design and analyses of clinical trials of adjuvant therapies.
OBJECTIVE: Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un). METHODS: A total of 14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: whether fewer than three N2 stations were explored, lobe-specific nodal dissection, extracapsular extension, highest lymph node station status, carcinoma in situ at the bronchial resection margin, and pleural lavage cytologic examination result. Revised categories of R0, R(un), R1, and R2 were tested for survival impact. RESULTS: In all, 14,293 cases were R0, 263 were R1, and 156 were R2 (median survivals not reached, 33 months, and 29 months, respectively). R status correlated with T and N categories. A total of 9290 cases (63%) had three or more N2 stations explored and 6641 cases (45%) had lobe-specific nodal dissection, correlated with increasing pN2. Extracapsular extension was present in 62 of 364 cases with available data (17%). The highest station was positive in 942 cases (6.4%). The pleural lavage cytologic examination result was positive in 59 of 1705 cases (3.5%): 13 had carcinoma in situ at the bronchial resection margin. After reassignment because of inadequate nodal staging in 56% of cases, 6070 cases were R0, 8185 were R(un), 301 were R1, and 156 were R2. In node-positive cases, the median survival times were 70, 50, and 30 months for R0, R(un) (p < 0.0001), and R1 (p < 0.001), respectively, with no significant difference between R0 and R(un) in pN0 cases. CONCLUSIONS: R descriptors have prognostic relevance, with R(un) survival stratifying between R0 and R1. Therefore, a detailed evaluation of R factor is of particular importance in the design and analyses of clinical trials of adjuvant therapies.
Authors: Raymond U Osarogiagbon; Nicholas R Faris; Walter Stevens; Carrie Fehnel; Cheryl Houston-Harris; Philip Ojeabulu; Olawale A Akinbobola; Yu-Shen Lee; Meredith A Ray; Matthew P Smeltzer Journal: J Thorac Oncol Date: 2019-11-26 Impact factor: 15.609
Authors: Raymond U Osarogiagbon; Matthew P Smeltzer; Nicholas R Faris; Meredith A Ray; Carrie Fehnel; Phillip Ojeabulu; Olawale Akinbobola; Meghan Meadows-Taylor; Laura M McHugh; Ahmed M Halal; Paul Levy; Vishal Sachdev; David Talton; Lynn Wiggins; Xiao-Ou Shu; Yu Shyr; Edward T Robbins; Lisa M Klesges Journal: J Thorac Oncol Date: 2021-02-16 Impact factor: 15.609
Authors: Meredith A Ray; Carrie Fehnel; Olawale Akinbobola; Nicholas R Faris; Meghan Taylor; Alicia Pacheco; Matthew P Smeltzer; Raymond U Osarogiagbon Journal: J Thorac Oncol Date: 2021-02-12 Impact factor: 15.609
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