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Real-life long-term outcomes of upfront surgery in patients with resectable stage I-IIIA non-small cell lung cancer

Marko Bitenc
Marko Bitenc
, 
Tanja Cufer
Tanja Cufer
, 
Izidor Kern
Izidor Kern
, 
Martina Miklavcic
Martina Miklavcic
, 
Sabrina Petrovic
Sabrina Petrovic
, 
Vida Groznik
Vida Groznik
 e 
Aleksander Sadikov
Aleksander Sadikov
   | 14 ago 2022
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Article Category: research article
Pubblicato online: 14 ago 2022
Pagine: 346 - 354
Ricevuto: 17 mag 2022
Accettato: 10 giu 2022
DOI: https://doi.org/10.2478/raon-2022-0030
© 2022 Marko Bitenc, Tanja Cufer, Izidor Kern, Martina Miklavcic, Sabrina Petrovic, Vida Groznik, Aleksander Sadikov, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1

Overall survival of patients with completely resected stage I–III A non-small cell lung cancer.
Overall survival of patients with completely resected stage I–III A non-small cell lung cancer.

Figure 2

Overall survival by clinical TNM stage (A), pathological TNM stage (B), clinical N stage (C) and pathological N stage (D).
Overall survival by clinical TNM stage (A), pathological TNM stage (B), clinical N stage (C) and pathological N stage (D).

Comparison between clinical and pathological T stage (n = 537; completeness = 99.6%)

cT1 (N = 240) N (%) cT2 (N = 193) N (%) cT3 (N = 96) N (%) cT4 (N = 8) N (%)
pT1 187 (78%) 24 (13%) 10 (10%) 2 (25%)
pT2 46 (19%) 158 (82%) 41 (43%) 3 (37%)
pT3 5 (2%) 9 (4%) 42 (44%) 2 (25%)
pT4 2 (1%) 2 (1%) 3 (3%) 1 (13%)

Comparison between clinical and pathological N stage (n = 534; completeness = 99.1%)

cN0 (N = 388) N (%) cN1 (N = 102) N (%) cN2 (N = 44) N (%)
pN0 324 (84%) 49 (48%) 13 (30%)
pN1 42 (11%) 34 (33%) 5 (11%)
pN2 22 (6%) 19 (19%) 26 (59%)

Demographic, clinicopathological and treatment characteristics of study population

Characteristic N (%)
No. of patients 539
Age in years: median (range) 64 (39–83)
              < 65 years 271 (50.3)
              ≥ 65 years 268 (49.7)
Gender
              Male 315 (58.4)
              Female 224 (41.6)
Smoking status (n = 537; completeness = 99.6 %)
              Current 257 (47.8)
              Former 212 (39.5)
              Never 68 (12.7)
Histology
              Adenocarcinoma 341 (63.3)
              Squamous-cell carcinoma 195 (36.2)
              NSCLC other rare types 3 (0.6)
EGFRa status in non-squamous NSCLC
              (n = 334; completeness = 99.7%)
              Positive 41 (12.3)
              Negative 292 (87.7)
ALKb status in non-squamous NSCLC
              (n = 334; completeness = 39.2%)
              Positive 7 (5.3)
              Negative 124 (94.7)
Clinical TNM stagec
              I 309 (57.3)
              II 145 (26.9)
              IIIA 85 (15.8)
Clinical T stage
              T1 242 (44.9)
              T2 193 (35.8)
              T3 96 (17.8)
              T4 8 (1.5)
Clinical N stage
              N0 393 (72.9)
              N1 102 (18.9)
              N2 44 (8.2)
Pathological TNM stagec (n = 532; completeness = 98.7%)
              I 296 (55.6)
              II 150 (28.2)
              III 86 (16.2)
Pathological T stage (n = 537; completeness = 99.6%)
              T1 223 (41.5)
              T2 248 (46.2)
              T3 58 (10.8)
              T4 8 (1.5)
Pathological N stage (n = 534; completeness = 99.1%
              N0 386 (72.3)
              N1 81 (15.2)
              N2 67 (12.5)
Surgery type
              Lobectomy 459 (85.2)
              Bilobectomy 31 (5.8)
              Pneumonectomy 49 (9.1)
Adjuvant treatment
              Platinum-based chemotherapy 146 (27.1)
              Postoperative radiotherapy 36 (6.7)

Univariate analyses of overall survival

Factor p-value HR (95% CI)
Age
          < 65 1
          ≥ 65 0.002 1.59 (1.18 – 2.15)
Gender
          Male 1
          Female 0.001 0.59 (0.43 – 0.81)
Smoking status
          never 1
          current or former 0.115 1.50 (0.91 – 2.47)
Histology
          adenocarcinoma or NOS 1
          squamous cell carcinoma 0.111 1.28 (0.95 – 1.73)
EGFR statusa (positive vs negative)
          negative 1
          positive 0.111 0.56 (0.27 – 1.14)
Clinical TNM stage 0.027*
          I 1
          II 0.034 1.44 (1.03 – 2.02)
          IIIA 0.025 1.57 (1.06 – 2.34)
Clinical T stage 0.001*
          T1 1
          T2 0.882 0.97 (0.69 – 1.38)
          T3 or T4 0.001 1.86 (1.29 – 2.68)
Clinical N stage 0.317*
          N0 1
          N1 0.958 0.99 (0.67 – 1.46)
          N2 0.137 1.44 (0.89 – 2.34)
Pathological TNM stage 0.003*
          I 1
          II 0.030 1.46 (1.04 – 2.06)
          IIIA 0.001 1.90 (1.29 – 2.79)
Pathological T stage 0.007*
          T1 1
          T2 0.019 1.49 (1.07 – 2.07)
          T3 or T4 0.004 1.92 (1.23 – 2.98)
Pathological N stage 0.002*
          N0 1
          N1 0.054 1.48 (0.99 – 2.20)
          N2 0.001 1.93 (1.29 – 2.87)

Multivariate analyses of overall survival (separate for clinical and for pathological stage)

Cox regression model with clinical stage p-value HR (95% CI)
Age
          < 65 1
          ≥ 65 0.003 1.58 (1.17 – 2.14)
Gender
          Male 1
          Female 0.006 0.63 (0.46 – 0.88)
Clinical TNM stage 0.092*
          I 1
          II 0.078 1.36 (0.97 – 1.91)
          IIIA 0.068 1.46 (0.97 – 2.18)
Cox regression model with pathological stage p-value HR (95% CI)
Age
          < 65 1
          ≥ 65 0.001 1.68 (1.24 – 2.28)
Gender
          Male 1
          Female 0.004 0.62 (0.45 – 0.86)
Pathological TNM stage 0.003*
          I 1
          II 0.076 1.37 (0.97 – 1.93)
          IIIA 0.001 1.95 (1.32 – 2.88)

Comparison between clinical (c) and pathological (p) TNM staging2A. Comparison between clinical and pathological TNM stage (n = 532; completeness = 98.7%)

c Stage I (N = 303) N (%) c Stage II (N = 144) N (%) c Stage IIIA (N = 85) N (%)
p Stage I 246 (81%) 38 (26%) 12 (14%)
p Stage II 40 (13%) 79 (55%) 31 (36%)
p Stage IIIA 17 (6%) 27 (19%) 42 (49%)
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