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Thorac Cardiovasc Surg 2014; 62(02): 109-116
DOI: 10.1055/s-0032-1329191
Original Thoracic
Georg Thieme Verlag KG Stuttgart · New York

T1aN0M0 and T1bN0M0 Non–Small Cell Lung Cancer: A Retrospective Study of the Prognosis

Zhenfa Zhang
1   Department of Lung Cancer, Lung Cancer Center, Tian Jin Medical University Cancer Institute and Hospital, Tian Jin, People's Republic of China
,
Anlei Wang
1   Department of Lung Cancer, Lung Cancer Center, Tian Jin Medical University Cancer Institute and Hospital, Tian Jin, People's Republic of China
,
Zhongli Zhan
2   Department of Pathology, Tian Jin Medical University Cancer Institute and Hospital, Tian Jin, People's Republic of China
,
Leina Sun
2   Department of Pathology, Tian Jin Medical University Cancer Institute and Hospital, Tian Jin, People's Republic of China
,
Kexin Chen
3   Department of Epidemiology, Tian Jin Medical University Cancer Institute and Hospital, Tian Jin, People's Republic of China
,
Changli Wang
1   Department of Lung Cancer, Lung Cancer Center, Tian Jin Medical University Cancer Institute and Hospital, Tian Jin, People's Republic of China
› Author Affiliations
Further Information

Publication History

04 April 2012

20 June 2012

Publication Date:
06 December 2012 (online)

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Abstract

Background Stage IA of non–small cell lung cancer (NSCLC) is divided into two subgroups, T1aN0M0 (d ≤ 2 cm) and T1bN0M0 (2 < d ≤ 3 cm), in the International Association for the Study of Lung Cancer, seventh edition of TNM Classification of Malignant Tumors.

Objective The purpose of this study was the identification of independent clinicopathological predictors of prognosis of these two subgroups of NSCLC.

Methods Between 1986 and 2005, a cohort of 1,929 cases of stage IA NSCLC in Tian Jin Medical University Cancer Institute and Hospital were retrospectively analyzed. The impact of clinicopathological characteristics on patients' survival was investigated.

Results The overall 5-year survival rate was 71.07%. Patients with T1aN0M0 NSCLC had a better 5-year survival than those with T1bN0M0 (73.98 vs. 68.18%, p = 0.0135). The Cox proportional hazard model revealed that the prognostic factors of T1aN0M0 were intratumoral vessel invasion (p = 0.035) and histologic differentiation (p = 0.004). In patients with T1bN0M0 NSCLC, the prognostic factors were histologic differentiation (p < 0.01), intratumoral vessel invasion (p < 0.01), removal of 6 or more lymph node stations (p < 0.01), and removal of lymph node station 7 (p < 0.01).

Conclusion Prognostic factors of T1aN0M0 and T1bN0M0 NSCLC are different. In patients with T1bN0M0 NSCLC, 6 or more lymph node stations and lymph node station 7 should be removed.

Keywords

T1aN0M0 - T1bN0M0 - non–small cell lung cancer - prognosis
 

  • References

  • 1 López-Encuentra A, Duque-Medina JL, Rami-Porta R, de la Cámara AG, Ferrando P. Bronchogenic Carcinoma Co-operative Group of the Spanish Society of Pneumology and Thoracic Surgery. Staging in lung cancer: is 3 cm a prognostic threshold in pathologic stage I non-small cell lung cancer? A multicenter study of 1,020 patients. Chest 2002; 121 (5) 1515-1520
    CrossrefPubMedSearch in Google Scholar
  • 2 Wisnivesky JP, Yankelevitz D, Henschke CI. The effect of tumor size on curability of stage I non-small cell lung cancers. Chest 2004; 126 (3) 761-765
    CrossrefPubMedSearch in Google Scholar
  • 3 Mery CM, Pappas AN, Burt BM , et al. Diameter of non-small cell lung cancer correlates with long-term survival: implications for T stage. Chest 2005; 128 (5) 3255-3260
    CrossrefPubMedSearch in Google Scholar
  • 4 Agarwal M, Brahmanday G, Chmielewski GW, Welsh RJ, Ravikrishnan KP. Age, tumor size, type of surgery, and gender predict survival in early stage (stage I and II) non-small cell lung cancer after surgical resection. Lung Cancer 2010; 68 (3) 398-402
    CrossrefPubMedSearch in Google Scholar
  • 5 UICC International Union Against Cancer. Lung and pleural tumors. In: Sobin LH, Gospodarowicz MK, Wittekind C, , eds. TNM Classification of Malignant Tumors. 7th ed. Oxford, England: Wiley-Blackwell; 2009: 138-146
    Search in Google Scholar
  • 6 Goldstraw P. The 7th edition of TNM in lung cancer: what now?. J Thorac Oncol 2009; 4 (6) 671-673
    CrossrefPubMedSearch in Google Scholar
  • 7 Patz Jr EF, Rossi S, Harpole Jr DH, Herndon JE, Goodman PC. Correlation of tumor size and survival in patients with stage IA non-small cell lung cancer. Chest 2000; 117 (6) 1568-1571
    CrossrefPubMedSearch in Google Scholar
  • 8 Yanagi S, Sugiura H, Morikawa T , et al. Tumor size does not have prognostic significance in stage IA NSCLC. Anticancer Res 2000; 20 (2B) 1155-1158
    PubMedSearch in Google Scholar
  • 9 Ye C, Masterman JR, Huberman MS , et al. Subdivision of the T1 size descriptor for stage I non-small cell lung cancer has prognostic value: a single institution experience. Chest 2009; 136 (3) 710-715
    CrossrefPubMedSearch in Google Scholar
  • 10 Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P. Members of IASLC Staging Committee. The IASLC Lung Cancer Staging Project: A proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 2009; 4: 568-577
    CrossrefPubMedSearch in Google Scholar
  • 11 Zhang Z, Xu F, Wang S, Li N, Wang C. Influence of smoking on histologic type and the efficacy of adjuvant chemotherapy in resected non-small cell lung cancer. Lung Cancer 2008; 60 (3) 434-440
    CrossrefPubMedSearch in Google Scholar
  • 12 Mountain CF, Carr DT, Anderson WAD. A system for the clinical staging of lung cancer. Am J Roentgenol Radium Ther Nucl Med 1974; 120 (1) 130-138
    CrossrefPubMedSearch in Google Scholar
  • 13 Flieder DB, Port JL, Korst RJ , et al. Tumor size is a determinant of stage distribution in T1 non-small cell lung cancer. Chest 2005; 128 (4) 2304-2308
    CrossrefPubMedSearch in Google Scholar
  • 14 Chang MY, Mentzer SJ, Colson YL , et al. Factors predicting poor survival after resection of stage IA non-small cell lung cancer. J Thorac Cardiovasc Surg 2007; 134 (4) 850-856
    CrossrefPubMedSearch in Google Scholar
  • 15 Christian C, Erica S, Morandi U. The prognostic impact of tumor size in resected stage I non-small cell lung cancer: evidence for a two thresholds tumor diameters classification. Lung Cancer 2006; 54 (2) 185-191
    CrossrefPubMedSearch in Google Scholar
  • 16 Goldstraw P, Crowley J, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2007; 2 (8) 706-714
    CrossrefPubMedSearch in Google Scholar
  • 17 Rami-Porta R, Ball D, Crowley JJ , et al; International Staging Committee; Cancer Research and Biostatistics; Observers to the Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol 2007; 2 (7) 593-602
    CrossrefPubMedSearch in Google Scholar
  • 18 Postmus PE, Brambilla E, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Cancer Research and Biostatistics; Observers to the Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer. J Thorac Oncol 2007; 2 (8) 686-693
    CrossrefPubMedSearch in Google Scholar
  • 19 Maeda R, Yoshida J, Ishii G , et al. Long-term survival and risk factors for recurrence in stage I non-small cell lung cancer patients with tumors up to 3 cm in maximum dimension. Chest 2010; 138 (2) 357-362
    CrossrefPubMedSearch in Google Scholar
  • 20 Suzuki K, Nagai K, Yoshida J. Conventional clinicopathologic prognostic factors in surgically resected nonsmall cell lung carcinoma. A comparison of prognostic factors for each pathologic TNM stage based on multivariate analyses. Cancer 1999; 86 (10) 1976-1984
    CrossrefPubMedSearch in Google Scholar
  • 21 Miyoshi K, Moriyama S, Kunitomo T, Nawa S. Prognostic impact of intratumoral vessel invasion in completely resected pathologic stage I non-small cell lung cancer. J Thorac Cardiovasc Surg 2009; 137 (2) 429-434
    CrossrefPubMedSearch in Google Scholar
  • 22 Naruke T. Significance of lymph node metastases in lung cancer. Semin Thorac Cardiovasc Surg 1993; 5 (3) 210-218
    PubMedSearch in Google Scholar
  • 23 Izbicki JR, Passlick B, Pantel K , et al. Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer: results of a prospective randomized trial. Ann Surg 1998; 227 (1) 138-144
    CrossrefPubMedSearch in Google Scholar
  • 24 Gajra A, Newman N, Gamble GP, Kohman LJ, Graziano SL. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J Clin Oncol 2003; 21 (6) 1029-1034
    CrossrefPubMedSearch in Google Scholar
  • 25 Wu YC, Lin C-FJ, Hsu WH, Huang BS, Huang MH, Wang LS. Long-term results of pathological stage I non-small cell lung cancer: validation of using the number of totally removed lymph nodes as a staging control. Eur J Cardiothorac Surg 2003; 24 (6) 994-1001
    CrossrefPubMedSearch in Google Scholar
  • 26 Ou SH, Zell JA. Prognostic significance of the number of lymph nodes removed at lobectomy in stage IA non-small cell lung cancer. J Thorac Oncol 2008; 3 (8) 880-886
    CrossrefPubMedSearch in Google Scholar
  • 27 Izbicki JR, Passlick B, Hosch SB , et al. Mode of spread in the early phase of lymphatic metastasis in non-small-cell lung cancer: significance of nodal micrometastasis. J Thorac Cardiovasc Surg 1996; 112 (3) 623-630
    CrossrefPubMedSearch in Google Scholar
  • 28 Gu CD, Osaki T, Oyama T , et al. Detection of micrometastatic tumor cells in pN0 lymph nodes of patients with completely resected nonsmall cell lung cancer: impact on recurrence and Survival. Ann Surg 2002; 235 (1) 133-139
    CrossrefPubMedSearch in Google Scholar