Exploring the Potential Different Outcomes Associated With the Different Phenotypes Under the Shared Pathologic T3N0 Designation

INTRODUCTION: The objective of this study was to compare overall survival (OS) between patients with pT1-2N1 versus pT3N0 NSCLC and various subtypes of pT3N0 NSCLC. METHODS: The National Cancer Database was queried to identify treatment-naive patients with pathologic stage IIB primary NSCLC. Patients were included if they were diagnosed with pT3N0 or pT1-2N1 NSCLC and received definitive surgery within 4 months of diagnosis. The pT3N0 cohort was subdivided by single versus multiple concurrent T3 descriptors and single-T3 subtypes. The 5-year OS was compared using the Kaplan-Meier method, and the Cox proportional-hazards model was used to identify prognostic factors for death. RESULTS: A total of 16,770 patients were included (pT3N0: 7179; pT1-2N1: 9591). pT3N0 NSCLC was associated with greater 5-year OS than pT1-2N1 NSCLC (52.4% versus 47.8%, p < 0.0001). Among patients receiving adjuvant chemotherapy after surgery, multiple-T3 pT3N0 NSCLC was associated with lower 5-year OS than single-T3 pT3N0 NSCLC (49.0% versus 63.3%, p < 0.0001), and chest wall-only pT3N0 NSCLC was associated with the lowest 5-year OS across single-T3 subtypes (additional nodule: 68.3%; size: 64.5%; chest wall: 52.2%, p < 0.0001). Adjuvant chemotherapy was associated with decreased risk of death in the pT3N0 cohort (hazard ratio = 0.65, confidence interval: 0.59–0.71, p < 0.0001). CONCLUSIONS: Patients with pT3N0 NSCLC experience greater 5-year OS after surgery compared with those with pT1-2N1 NSCLC. Multiple-T3 and chest wall-only pT3N0 NSCLC are associated with worse 5-year OS and increased risk of death relative to other T3 subtypes. Future staging systems should consider including notation distinguishing multiple T3 descriptors in pT3N0 NSCLC.