Reconsidering the T category for the T3 non-small cell lung cancer with additional tumor nodules in the same lobe: A population-based study

BACKGROUND: This study aimed to evaluate the prognosis of the T3 non-small cell lung cancer (NSCLC) patients with additional tumor nodules in the same lobe (T3-Add), and externally validate the current T category of this population. METHODS: NSCLC data deposited in the Surveillance, Epidemiology, and End Results (SEER) dataset was extracted. Survivals were estimated using the Kaplan-Meier method with a log-rank test. Propensity score matching (PSM) was performed to reduce bias. The least absolute shrinkage and selection operator (LASSO)-penalized Cox model was used to determine the prognostic factors. RESULTS: A total of 41,370 eligible cases were included. There were 2,312, 20,632, 12,787, 3,374 and 2,265 cases in the T3-Add, T1, T2, T3 and T4 group, respectively. The Kaplan-Meier curves demonstrated that the survivals of the T3-Add patients were superior to those of the T3 patients both before and after PSM. Additionally, the OS of the T3-Add patients were worse than that of the T2 patients, but the CSS differences between these two groups were not statistically significant. In the subset analyses, the survivals of the T3-Add patients were inferior to those of the T2a patients, but were comparable to those of the T2b patients (5-year OS rate: 54.3% vs. 57.2%, P = 0.884; 5-year CSS rate: 76.2% vs. 76.8%, P = 0.370). In the T3-Add & T2b matched pair, multivariable Cox analysis further confirmed that T category was not a prognostic factor for survivals. CONCLUSION: T3-Add and T2b NSCLC patients had similar survivals, and we proposed that it is necessary to reconsider the T category of the patients with additional nodules in the same lobe in the forthcoming 9(th) edition of TNM staging manual.