验证IASLC提议的残存肿瘤分期法将肿瘤淋巴结包膜外侵犯从R0改进为不完全切除

SCI

21 August 2023

Validation of the proposed IASLC residual tumor classification to upgrade extracapsular extension of tumor in nodes from R0 to incomplete resection

(Journal of thoracic oncology；IF:20.4)

Xie H, Dai C, Gu C, Zhao S, Xu L, Wang F, Gao J, Su H, Wu J, She Y, Ren Y, Wu C, Chen C, Validation of the proposed IASLC residual tumor classification to upgrade extracapsular extension of tumor in nodes from R0 to incomplete resection, Journal of Thoracic Oncology (2023), doi: https://doi.org/10.1016/j.jtho.2023.08.003. 

Correspondence Author: Chang Chen, Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, 200443, China, E-mail: chenthoracic@163.com

Objectives 目的

The International Association for the Study of Lung Cancer proposed a revised R classification to upstage extracapsular extension (ECE) of tumor in nodes from R0 to R1. However, evidence to confirm this proposal is insufficient. 

国际肺癌研究协会提出了一种改进的R分期，使肿瘤淋巴结包膜外侵犯（ECE）从R0上升至R1分期。然而，证实这一提议的证据尚不足。

Methods 方法

The study included 4,061 surgical patients with non-small cell lung cancer. After reclassification by IASLC-R classification, overall survival (OS) was analyzed to compare patients with ECE to those with R0, R(un), and incomplete resection (R1/R2). The recurrence pattern of ECE was evaluated to determine whether it correlated with incomplete resection.

对4061例手术治疗的非小细胞肺癌患者进行研究。采用IASLC-R分期进行再分期后，分析比较ECE与R0、R(un)和不完全切除（R1/R2）患者的总生存期（OS）。评估ECE的复发模式，以确定其是否与不完全切除相关。

Results 结果

Among 1,136 patients with N disease, those without ECE (n=754, 72%) had a significantly better OS than those with ECE (n=382, 28%) (p<0.001). This negative prognostic significance was consistent across multiple subgroups. Multivariate analysis showed that ECE was an independent prognostic risk factor (p<0.001). When patients with ECE were separated from the IASLC-R1 group, their OS was significantly worse than that of IASLC-R(un) patients, but comparable to that of the remaining patients in the IASLC-R1 patients when analyzing all patients and patients with N disease. Moreover, patients with ECE had an increased risk of local recurrence in the mediastinum (p<0.001), ipsilateral lung (p=0.031), and malignant pleural effusion/nodes (p=0.004) but not distant recurrence including contralateral/both lungs (p=0.268), liver (p=0.728), brain (p=0.252), or bone (p=0.322). 

1136例N病患者中，无ECE组（754例，72%）的OS明显优于ECE组（382例，28%）（p<0.001）。这种负面的预后意义在多个亚组中是一致的。多变量分析法显示ECE是影响预后的独立危险因素（p<0.001）。当ECE患者与IASLC-R1组分离时，其OS显著低于IASLC-R(un)患者，但在分析所有患者和N病患者时，其OS与IASLC-R1组的剩余患者相当。此外，ECE患者在纵隔（p<0.001）、同侧肺（p=0.031）和恶性胸腔积液/淋巴结（p=0.004）的局部复发风险增加，但包括对侧/双肺（p=0.268）、肝脏（p=0.728）、脑（p=0.252）或骨（p=0.322）的远处复发风险不增加。

Conclusions 结论

The prognosis of ECE patients is comparable to that of R1 patients. Moreover, their higher risk of local recurrence strongly suggests the presence of occult residual tumor cells in the surgical hemithoracic cavity. Therefore, upgrading ECE into incomplete resection is reasonable.

ECE患者的预后与R1患者相当。此外，其局部复发的高风险强烈提示手术的半胸腔内存在隐匿的残余肿瘤细胞。因此，将ECE改进为不完全切除是合理的。

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