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

Junghee Lee, Yun Soo Hong, Juhee Cho, Jin Lee, Genehee Lee, Danbee Kang, Jeonghee Yun, Yeong Jeong Jeon, Sumin Shin, Jong Ho Cho, Yong Soo Choi, Jhingook Kim, Jae Ill Zo, Young Mog Shim, Eliseo Guallar, Hong Kwan Kim

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1 Scopus citations

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 5-year 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.

Original languageEnglish
Pages (from-to)890-899
Number of pages10
JournalJournal of Thoracic Oncology
Volume17
Issue number7
DOIs
StatePublished - Jul 2022

Keywords

  • Inadequate nodal assessment
  • Non–small cell lung cancer
  • Residual tumor
  • Systematic nodal dissection
  • Uncertain resection

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