Prognostic Factors and Survival in Resected T4 Non-small Cell Lung Cancer: Is There Any Difference in the T4 Subgroups?

Abstract

Introduction The eighth edition of the TNM classification revised the subgroups of T4 non-small cell lung cancer (NSCLC). This study aimed to compare the T4-NSCLC subgroups that underwent surgical treatment in terms of mortality, morbidity, survival, and prognostic factors based on the new classification. Materials and Methods Between 2000 and 2014, a total of 284 T4-NSCLC patients who underwent lung resection (mediastinal organ invasion, n = 114; ipsilateral different lobe tumors, n = 32; and tumors larger than 7 cm, n = 138) were included in the present study. Results Surgical mortality and morbidity were 5.6% (n = 16) and 23.9% (n = 68), respectively. The 5-year survival rates were 46% for ipsilateral different lobe tumors, 45.4% for tumours larger than 7 cm, and 36.6% for mediastinal organ invasion (28% for patients with heart/atrium invasion, 43.3% for carina invasion, 37.5% for large vessel invasion) (p = 0.223). Age above 65 (p = 0.002, HR = 1.781), pN2 versus pN0/1 (p < 0.0001, HR = 2.564), incomplete resection (p = 0.003, HR = 2.297), and pneumonectomy (p = 0.02, HR = 1.524) were identified as poor prognostic survival factors. According to multivariate analysis, mediastinal lymph node metastasis (p = 0.001) and incomplete resection (p = 0.0026) were the independent negative risk factors for survival. Conclusion According to the results of our study, surgical treatment is a good option in T4-NSCLC patients who have no mediastinal lymph node metastasis and are completely resectable. There is no difference in terms of survival among the T4 subgroups. The eighth edition of the TNM classification has a better prognostic definition than the previous version.

Prognostic Factors in Patients with Clinic Locally Advanced T4 Lung Cancer: Surgical Considerations

“…4 Similarly, Aksoy et al's study with 284 T4 NSCLC cases who had surgery found 5.6% mortality and 23.9% morbidity rate. 5 Yamanashi et al's study investigating results of 93 cases stated 30-day mortality as 0%, with a complication rate of 56%. 2 Comparing with these studies' mortality and morbidity rates, it is possible to say that our mortality rate is similar, but a higher morbidity rate was observed.…”

Correlation between outcomes and tumor size in >7 cm T4 non-small cell lung cancer patients: A tumor size-based comparison study

“…The impact of non-size-based T4 features on survival in NSCLC patients with tumors >7 cm in size is controversial. 8,9 Another controversial issue is whether there is a survival difference between T4 cases classified based on tumor size or not. Ichinose et al 10 suggested that T4 tumors classified based on size should be treated differently from those not classified based on size.…”