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Reclassifying the International Association for the Study of Lung Cancer Residual Tumor Classification According to the Extent of Nodal Dissection for NSCLC: One Size Does Not Fit All
- Title
- Reclassifying the International Association for the Study of Lung Cancer Residual Tumor Classification According to the Extent of Nodal Dissection for NSCLC: One Size Does Not Fit All
- Authors
- Lee, Junghee; Hong, Yun Soo; Cho, Juhee; Lee, Jin; Lee, Genehee; Kang, Danbee; Yun, Jeonghee; Jeon, Yeong Jeong; Shin, Sumin; Cho, Jong Ho; Choi, Yong Soo; Kim, Jhingook; Zo, Jae Ill; Shim, Young Mog; Guallar, Eliseo; Kim, Hong Kwan
- Ewha Authors
- 신수민
- SCOPUS Author ID
- 신수민
- Issue Date
- 2022
- Journal Title
- JOURNAL OF THORACIC ONCOLOGY
- ISSN
- 1556-0864
1556-1380
- Citation
- JOURNAL OF THORACIC ONCOLOGY vol. 17, no. 7, pp. 890 - 899
- Keywords
- Residual tumor; Non-small cell lung cancer; Uncertain resection; Inadequate nodal assessment; Systematic nodal dissection
- Publisher
- ELSEVIER SCIENCE INC
- Indexed
- SCIE; SCOPUS
- Document Type
- Article
- Abstract
- Introduction: The extent of nodal assessment may require risk-based adjustments in NSCLC. We reclassified the International Association for the Study of Lung Cancer Residual tumor classification according to the extent of nodal dissection and evaluated its long-term prognosis by tumor stage and histologic subtype. Methods: We reclassified 5117 patients who underwent resection for clinical stages I to III NSCLC and had complete or uncertain resection by International Association for the Study of Lung Cancer classification into the following 3 groups according to compliance with three components (N1, N2, and subcarinal node) of systematic nodal dissection criteria: fully compliant group (FCG), partially compliant group (PCG), and noncompliant group (NCG). Recurrence-free survival (RFS) and overall survival (OS) were compared. Results: Of the 5117 patients, 2806 (55%), 1959 (38%), and 359 (7%) were FCG, PCG, and NCG, respectively. PCG and NCG were more likely to be of lower clinical stage and adenocarcinoma with lepidic component than FCG. The 5year RFS and OS were significantly better in NCG than in FCG or PCG (RFS, 86% versus 70% or 74%, p < 0.001; OS, 90% versus 80% or 83%, p < 0.001). In particular, NCG had better RFS and OS than FCG or PCG in clinical stage I and in lepidic-type adenocarcinoma. Conclusions: In early stage NSCLC with low-risk histologic subtype, a less rigorous nodal assessment was not associated with a worse prognosis. Although surgeons should continue to aim for complete resection and thorough nodal assessment, a uniform approach to the extent and invasiveness of nodal assessment may need to be reconsidered. (C) 2022 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
- DOI
- 10.1016/j.jtho.2022.03.015
- Appears in Collections:
- 의과대학 > 의학과 > Journal papers
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