Predictors of nodal upstaging in clinical N1 nonsmall cell lung cancer

Hidenao Kayawake; Jiro Okami; Yasushi Shintani; Hiroyuki Ito; Takashi Ohtsuka; Shinichi Toyooka; Takeshi Mori; Shun-Ichi Watanabe; Hisao Asamura; Masayuki Chida; Shunsuke Endo; Mitsutaka Kadokura; Ryoichi Nakanishi; Etsuo Miyaoka; Ichiro Yoshino; Hiroshi Date; Japanese Joint Committee of Lung Cancer Registry

doi:10.1093/jjco/hyae161

Predictors of nodal upstaging in clinical N1 nonsmall cell lung cancer

Jpn J Clin Oncol. 2024 Nov 13:hyae161. doi: 10.1093/jjco/hyae161. Online ahead of print.

Authors

Hidenao Kayawake^{1

2}, Jiro Okami³, Yasushi Shintani⁴, Hiroyuki Ito⁵, Takashi Ohtsuka⁶, Shinichi Toyooka⁷, Takeshi Mori⁸, Shun-Ichi Watanabe⁹, Hisao Asamura¹⁰, Masayuki Chida¹¹, Shunsuke Endo¹², Mitsutaka Kadokura¹³, Ryoichi Nakanishi¹⁴, Etsuo Miyaoka¹⁵, Ichiro Yoshino¹⁶, Hiroshi Date¹; Japanese Joint Committee of Lung Cancer Registry

Affiliations

¹ Department of Thoracic Surgery, Kyoto University, 54, Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan.
² Department of Thoracic Surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-ku, Kobe 650-0047, Japan.
³ Department of General Thoracic Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-Ku, Osaka 540-0008, Japan.
⁴ Department of General Thoracic Surgery, Graduate School of Medicine, Osaka University, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan.
⁵ Department of Thoracic Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi, Yokohama, Kanagawa 241-8515, Japan.
⁶ Division of Thoracic Surgery, Department of Surgery, Jikei University School of Medicine, Nishishinbashi 3-19-18, Minatoku, Tokyo 105-8471, Japan.
⁷ Department of Thoracic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan.
⁸ Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1, Nagamine-minami, Higashi-ku, Kumamoto 861-8520, Japan.
⁹ Department of Thoracic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
¹⁰ Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
¹¹ Department of General Thoracic Surgery, Dokkyo Medical University 880 Kitakobayashi, Mibu, Tochigi 321-0293, Japan.
¹² Department of Thoracic Surgery, Jichi Medical School, 3311-1 Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
¹³ Respiratory Disease Center, Showa University Yokohama Hospital, 35-1 Chigasakichuo, Tsuzuki-ku, Yokohama, Kanagawa 224-8503, Japan.
¹⁴ Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
¹⁵ Department of Mathematics, Tokyo University of Science, 1-3 Kagurazaka, Shinjuku-ku Tokyo 162-8601, Japan.
¹⁶ Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 260-8670, Japan.

PMID: 39537201
DOI: 10.1093/jjco/hyae161

Abstract

Background: Surgical resection followed by adjuvant chemotherapy is currently the first choice for the treatment of clinical N1 (cN1) non-small cell lung cancer (NSCLC). However, diagnosing cN1 correctly can be difficult, even with current imaging diagnostic technologies. We aimed to analyze the diagnostic accuracy of preoperative nodal status and the predictive factors for nodal upstaging of cN1-NSCLC.

Methods: Patients receiving surgery for cN1-NSCLC in 2010 (n = 1040) were enrolled in the Japanese Joint Committee of Lung Cancer Registry Database. We investigated the diagnostic accuracy of cN1, predictive factors for nodal upstaging, and prognostic factors for overall survival (OS) and recurrence-free survival (RFS).

Results: The 5-year OS and RFS for all patients were 58.2% and 42.7%, respectively. The postoperative pathological nodal status included N0 (36.6%), N1 (39.7%), N2 (23.6%), and N3 (0.1%). In multivariate analysis, younger age (P = .005), no history of smoking (P = .006), and adenocarcinoma (P < .001) were significant predictive factors for nodal upstaging. Older age (P < .001) and higher clinical T (cT) factor (P < .001) were significant indicators for worse OS, while older age (P = .02), higher cT factor (P = .019), high carcinoembryonic antigen value (P = .002), and adenocarcinoma (P = .008) were significant indicators for worse RFS.

Conclusions: The diagnostic accuracy of cN1 in this study was ~40%. No history of smoking and adenocarcinoma were significant predictors for nodal upstaging. Although younger age was a significant predictor for nodal upstaging, it was a significant factor for better prognosis.

Keywords: clinical N1 nonsmall cell lung cancer; diagnostic accuracy; nodal upstaging; predictive factor; prognostic factor.