Cancer Res Treat.  2025 Jan;57(1):105-115. 10.4143/crt.2024.150.

Recurrence Dynamics of Pathological N2 Non–Small Cell Lung Cancer Based on IASLC Residual Tumor Descriptor

• Kim IH
• Lee GD
• Choi S
• Kim HR
• Kim YH
• Kim DK
• Park SI
• Yun JK

• KMID: 2564585
• DOI: http://doi.org/10.4143/crt.2024.150

Abstract

Purpose
This study investigated the recurrence patterns and timing in patients with pathologic N2 (pN2) non-small cell lung cancer (NSCLC) according to the residual tumor (R) descriptor proposed by the International Association for the Study of Lung Cancer (IASLC).
Materials and Methods
From 2004 to 2021, patients with pN2 NSCLC who underwent anatomical resection were analyzed according to the IASLC R criteria using medical records from a single center. Survival analysis was performed using Cox proportional hazards models. Recurrence patterns between complete (R0) and uncertain resections (R[un]) were compared.
Results
In total, 1,373 patients were enrolled in this study: 576 (42.0%) in R0, 286 (20.8%) in R(un), and 511 (37.2%) in R1/R2 according to the IASLC R criteria. The most common reason for R(un) classification was positivity for the highest lymph node (88.8%). In multivariable analysis, the hazard ratios for recurrence in R(un) and R1/R2 compared to R0 were 1.18 (95% confidence interval [CI], 0.96–1.46) and 1.58 (1.31–1.90), respectively. The hazard rate curves displayed similar patterns among groups, peaking at approximately 12 months after surgery. There was a significant difference in distant recurrence patterns between R0 and R(un). Further analysis after stratification with the IASLC N2 descriptor showed significant differences in distant recurrence patterns between R0 and R(un) in patients pN2a1 and pN2a2 disease, but not in those with pN2b disease.
Conclusion
The IASLC R criteria has prognostic relevance in patients with pN2 NSCLC. R(un) is a highly heterogeneous group, and the involvement of the highest mediastinal lymph node can affect distant recurrence patterns.

Keyword

Lung neoplasms; N2; Residual tumor; Recurrence

Figure

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  Fig. 1. Flowchart of this study. IASLC, International Association for the Study of Lung Cancer; NSCLC, non–small cell lung cancer; R0, complete resection; R(un), uncertain resection; R1/2, incomplete resection.

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  Fig. 2. (A) Disease-free survival of patients with pathologic N2 disease according to the IASLC R classification. (B) Overall survival of patients with pathologic N2 disease according to the IASLC R classification. (C) Hazard rate for recurrence of patients with pathologic N2 disease according to the IASLC R classification. IASLC, International Association for the Study of Lung Cancer; R, residual tumor; R0, complete resection; R1/2, incomplete resection; R(un), uncertain resection.

Reference

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