Impact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancer
Abstract The evolving TNM classification has emphasized the tumor size’s role in NSCLC prognosis, reclassifying stage IIIA patients from the previous edition as stage IIIB (T3-4N2M0, 8th edition). However, the prognostic implications of tumor size and survival in stage III NSCLC patients undergoing...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2025-05-01
|
| Series: | Scientific Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1038/s41598-024-82946-y |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849309738434560000 |
|---|---|
| author | Junghee Lee Jin Lee Yun Soo Hong Genehee Lee Jiyoun Park Yeong Jeong Jeon Seong-Yong Park Jong Ho Cho Yong Soo Choi Jhingook Kim Young Mog Shim Eliseo Guallar Juhee Cho Hong Kwan Kim |
| author_facet | Junghee Lee Jin Lee Yun Soo Hong Genehee Lee Jiyoun Park Yeong Jeong Jeon Seong-Yong Park Jong Ho Cho Yong Soo Choi Jhingook Kim Young Mog Shim Eliseo Guallar Juhee Cho Hong Kwan Kim |
| author_sort | Junghee Lee |
| collection | DOAJ |
| description | Abstract The evolving TNM classification has emphasized the tumor size’s role in NSCLC prognosis, reclassifying stage IIIA patients from the previous edition as stage IIIB (T3-4N2M0, 8th edition). However, the prognostic implications of tumor size and survival in stage III NSCLC patients undergoing neoadjuvant therapy remain unexplored. Therefore, we investigated the association between tumor size and mortality in N2 non-small cell lung cancer (NSCLC) patients undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery (trimodality therapy), considering the number of metastatic N2 stations and histology. We analyzed 756 patients with stage III (T1-3N2) NSCLC who underwent trimodality therapy, excluding those with T3 tumors with invasion components or additional nodules (2003–2019). Overall survival was compared using the Cox-proportional hazards model, while the tumor size-survival relationship was estimated using restricted cubic splines. Using 8th TNM edition, 32.1%, 48.5%, and 19.3% were clinical T1, T2, and T3. During a median follow-up of 53.5 months, 398 patients died. The adjusted hazard ratios for overall survival comparing T2 and T3 to T1 were 1.46 (95% confidence interval, 1.14–1.85) and 1.48 (1.10–1.99). For the extent of clinical N2, large tumor size increased the mortality risk in patients with N2b but not in N2a. Tumor size did not increase mortality risk in squamous cell carcinoma patients; however, the mortality risk was increased with larger tumors in adenocarcinoma. These findings raise the importance of considering tumor size in treatment planning and suggesting tailored strategies. |
| format | Article |
| id | doaj-art-8ca80d9eca4845a1a94cc12b203d9df7 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | Scientific Reports |
| spelling | doaj-art-8ca80d9eca4845a1a94cc12b203d9df72025-08-20T03:53:58ZengNature PortfolioScientific Reports2045-23222025-05-0115111110.1038/s41598-024-82946-yImpact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancerJunghee Lee0Jin Lee1Yun Soo Hong2Genehee Lee3Jiyoun Park4Yeong Jeong Jeon5Seong-Yong Park6Jong Ho Cho7Yong Soo Choi8Jhingook Kim9Young Mog Shim10Eliseo Guallar11Juhee Cho12Hong Kwan Kim13Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan UniversityDepartment of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public HealthDepartment of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan UniversityDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterDepartment of Epidemiology, School of Global Public Health, New York UniversityDepartment of Epidemiology and Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University Bloomberg School of Public HealthDepartment of Thoracic and Cardiovascular Surgery, Sungkyunkwan University School of Medicine, Samsung Medical CenterAbstract The evolving TNM classification has emphasized the tumor size’s role in NSCLC prognosis, reclassifying stage IIIA patients from the previous edition as stage IIIB (T3-4N2M0, 8th edition). However, the prognostic implications of tumor size and survival in stage III NSCLC patients undergoing neoadjuvant therapy remain unexplored. Therefore, we investigated the association between tumor size and mortality in N2 non-small cell lung cancer (NSCLC) patients undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery (trimodality therapy), considering the number of metastatic N2 stations and histology. We analyzed 756 patients with stage III (T1-3N2) NSCLC who underwent trimodality therapy, excluding those with T3 tumors with invasion components or additional nodules (2003–2019). Overall survival was compared using the Cox-proportional hazards model, while the tumor size-survival relationship was estimated using restricted cubic splines. Using 8th TNM edition, 32.1%, 48.5%, and 19.3% were clinical T1, T2, and T3. During a median follow-up of 53.5 months, 398 patients died. The adjusted hazard ratios for overall survival comparing T2 and T3 to T1 were 1.46 (95% confidence interval, 1.14–1.85) and 1.48 (1.10–1.99). For the extent of clinical N2, large tumor size increased the mortality risk in patients with N2b but not in N2a. Tumor size did not increase mortality risk in squamous cell carcinoma patients; however, the mortality risk was increased with larger tumors in adenocarcinoma. These findings raise the importance of considering tumor size in treatment planning and suggesting tailored strategies.https://doi.org/10.1038/s41598-024-82946-yTumor sizeN2NeoadjuvantNon-small cell lung cancerTrimodality therapySurgery |
| spellingShingle | Junghee Lee Jin Lee Yun Soo Hong Genehee Lee Jiyoun Park Yeong Jeong Jeon Seong-Yong Park Jong Ho Cho Yong Soo Choi Jhingook Kim Young Mog Shim Eliseo Guallar Juhee Cho Hong Kwan Kim Impact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancer Scientific Reports Tumor size N2 Neoadjuvant Non-small cell lung cancer Trimodality therapy Surgery |
| title | Impact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancer |
| title_full | Impact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancer |
| title_fullStr | Impact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancer |
| title_full_unstemmed | Impact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancer |
| title_short | Impact of tumor size by clinical N subclassification and histology in trimodality-treated N2 non-small cell lung cancer |
| title_sort | impact of tumor size by clinical n subclassification and histology in trimodality treated n2 non small cell lung cancer |
| topic | Tumor size N2 Neoadjuvant Non-small cell lung cancer Trimodality therapy Surgery |
| url | https://doi.org/10.1038/s41598-024-82946-y |
| work_keys_str_mv | AT jungheelee impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT jinlee impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT yunsoohong impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT geneheelee impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT jiyounpark impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT yeongjeongjeon impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT seongyongpark impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT jonghocho impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT yongsoochoi impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT jhingookkim impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT youngmogshim impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT eliseoguallar impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT juheecho impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer AT hongkwankim impactoftumorsizebyclinicalnsubclassificationandhistologyintrimodalitytreatedn2nonsmallcelllungcancer |