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Prognostic Significance of the Non–Size-Based AJCC T2 Descriptors^*

Visceral Pleura Invasion, Hilar Atelectasis, or Obstructive Pneumonitis in Stage IB Non-small Cell Lung Cancer Is Dependent on Tumor Size

^* From the Chao Family Comprehensive Cancer Center (Drs. Ou and Zell), Division of Hematology/Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, CA; and Genetic Epidemiology Research Institute (Drs. Ziogas and Anton-Culver), University of California Irvine, Irvine CA.

Correspondence to: Sai-Hong Ignatius Ou, MD, PhD, Chao Family Comprehensive Cancer Center, University of California Irvine Medical Center, 101 The City Dr South, Building 56, Room 241, RT 81, Orange, CA 92868-3298; e-mail: ignatius.ou{at}uci.edu

Abstract

Background: The T2 descriptor for staging non-small cell lung cancer (NSCLC) contains several non–size-based criteria. It remains unknown whether the prognostic significance of these non–size-based criteria is dependent on tumor size.

Methods: A total of 10,545 patients with stage IB NSCLC from the California Cancer Registry between 1989 to 2003 were categorized into the following three nonoverlapping criteria: (1) tumor size (T2S); (2) visceral pleura invasion, hilar atelectasis, or obstructive pneumonitis (T2P); and (3) main bronchus involvement 2 cm from the carina (T2C). Univariate survival analyses were performed using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios.

Results: A total of 51.1% of patients with stage IB NSCLC were staged by T2S, 43.2% by T2P, and 5.7% by T2C; 2,224 stage IB patients (total, 21.1%; 18.9% T2P + 2.2% T2C) had tumors 3 cm in size. The 5-year survival rate and the median survival time of these stage IB patients with tumors 3 cm in size were as follows: T2P, 51.2% and 64 months, respectively; T2C, 49.0% and 58 months, respectively. These values were similar to the 53.2% 5-year survival rate and 67-month median survival time for patients with stage IA NSCLC (p = 0.40). Cox proportional hazards model revealed T2P of > 3 cm was a poor prognostic factor for survival (vs T2S; hazard ratio [HR], 1.16; 95% confidence interval [CI], 1.08 to 1.24). Conversely, T2P 3 cm was a favorable prognostic factor for survival (vs T2S; HR, 0.89; 95% CI, 0.82 to 0.96). T2C was not an independent prognostic factor for survival.

Conclusions: Prognostic significance of the non–size-based T2 descriptor T2P is dependent on tumor size.

Key Words: hilar atelectasis • obstructive pneumonitis • stage I lung cancer • T2 descriptor • visceral pleura invasion

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