Journal Article Epublish
PubMed: 41749955 DOI: 10.3390/cancers18040702
Validation of the 9th Edition of the TNM Classification in Patients with NSCLC and Lymph Node Involvement: A Retrospective, Multicentric, Observational Study.
Cancers (Basel) 18(4)
Authors: Carolina Sassorossi, Marco Chiappetta, Filippo Lococo, Gloria Santoro, Pierluigi Novellis, Giulia Veronesi, Riccardo Di Fonzo, Filippo Tommaso Gallina, Francesco Facciolo, Vittorio Aprile, Alessandra Lenzini, Marco Lucchi, Sara Ricciardi, Giuseppe Cardillo, Andrea Tornese, Ludovic Fournel, Marco Alifano, Stefano Margaritora
Affiliations
- Unit of Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
- Thoracic Surgery, AOU Renato Dulbecco, Magna Graecia University, 88100 Catanzaro, Italy.
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy.
- Department of Thoracic Surgery, IRCCS Ospedale San Raffaele, 20132 Milan, Italy.
- Thoracic Surgery Unit, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy.
- Thoracic Surgery, Department of Surgical, Medical and Molecular Pathology and Critical Care, University of Pisa, 56126 Pisa, Italy.
- Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini, 00152 Rome, Italy.
- Unit of Anatomy and Pathological Histology, Azienda Ospedaliera San Camillo-Forlanini, Carlo Forlanini Hospital, 00151 Rome, Italy.
- Department of Thoracic Surgery, Cochin Hospital, Paris-Descartes-University, 75014 Paris, France.
Abstract
BACKGROUND
The ninth edition of the TNM classification introduced refinements in nodal staging, subdividing mediastinal N2 disease into N2a (single-station) and N2b (multi-station) involvement, alongside several stage group adjustments. The aim of this study is to validate the new TNM in patients with nodal involvement who underwent surgery.
METHODS
This is a multicentric, retrospective study including NSCLC patients with pathological N1 or N2 involvement who underwent anatomical pulmonary resection between January 2020 and December 2023. Clinical, surgical, and pathological data were collected, including tumor characteristics, lymphadenectomy details, and adjuvant therapy. Patients were reclassified according to the ninth TNM groups: stage IIB, including T1N1, T2N1, and T3N0; IIIA, including T1N2b, T2-3N2a, T3N1, T4N0, and T4N1; and IIIB, including T2-3N2b, T4N2a, and T4N2b. Overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan-Meier curves.
RESULTS
The final analysis involved 291 patients. The three- and five-year OS rates were 82% and 71% for stage IIB, and 75% and 58% for stage IIIA, respectively. At stage IIB, a significant difference was found only for DFS comparing T2N1 and T1N2a, whereas stage IIIA showed no significant differences in either OS or DFS, confirming its prognostic homogeneity. Conversely, stage IIIB exhibited significant heterogeneity in survival (OS p = 0.031; DFS p < 0.0001), with T4N2b subgroups showing the worst outcomes compared to T2-3N2b and T4N2a.
CONCLUSIONS
Our validation of the ninth edition of lung cancer staging shows improved prognostic granularity: IIB shows non-homogeneous DFS, IIIA is homogeneous, and IIIB shows major OS/DFS substage differences, warranting analyses with larger samples for refined stratification.
MeSH
Lymph Nodes, Neoplasms, Multiple Chronic Conditions, Classification, Carcinoma, Non-Small-Cell Lung, Lymph