Introduction

To evaluate the prognosis between patients with non-small cell lung cancer (NSCLC) invading difference depth of chest wall and estimate the impact of rib invasion on the pathological T classifications (pT).

Methods

We retrospectively evaluated 521 patients with resected pT3-4 NSCLC. Propensity-score matching (PSM) balanced the known confounders of the prognosis, resulting in two sets (rib invasion vs the pT3 and pT4 group). Recurrence-free survival (RFS) and Overall survival (OS) was assessed by Cox regression and Kaplan-Meier methods. Time-dependent receiver operating characteristic (ROC) curves were used to assess the additional benefit for survival prediction after reclassifying rib invasion cases.

Results

Chest wall invasion occurred in 171 patients (62 rib invasion, 51 parietal pleural invasion [PL3] and 58 soft tissue invasion). Rib invasion was found to be an independent prognostic factor for both RFS (p = 0.006) and OS (p < 0.001) of pT3-4 NSCLC. The survival of rib invasion group was the worst (RFS: 13.1%; OS: 19.8%), followed by PL3 (RFS: 34.2%, P = 0.001; OS: 48.8%; p < 0.001) and the soft tissue invasion group (RFS: 40.6%, p = 0.001; OS: 57.7%, p < 0.001). Besides, the prognosis of rib invasion group was also found to be worse than those of pT3 (RFS: p < 0.001; OS: p < 0.001) and pT4 group (RFS: p = 0.002; OS: p < 0.001). After PSM, the 5-year RFS rate of rib invasion group were still lower than that of pT3 and pT4 group (p < 0.001); the 5-year OS rate of rib invasion was similar with that of pT4 group (p = 0.066) but lower than that of pT3 group (p = 0.014). The time-dependent ROC curves demonstrated that reclassifying rib invasion as pT4 disease provided an additional benefit for survival prediction (p < 0.001).

Conclusion

The rib invasion group had a worse prognosis than the PL3 and pT3 groups. The prognostic impact of rib invasion should be further validated as a pT4 disease in the TNM classification.

中文翻译：

---

肋骨浸润作为非小细胞肺癌独立 T 描述子的建议：倾向评分匹配分析

介绍

评估非小细胞肺癌（NSCLC）患者胸壁浸润深度差异的预后，并评估肋骨浸润对病理T分型（pT）的影响。

方法

我们回顾性评估了 521 名已切除 pT3-4 NSCLC 的患者。倾向评分匹配 (PSM) 平衡了已知的预后混杂因素，产生了两组（肋骨侵犯与 pT3 和 pT4 组）。通过 Cox 回归和 Kaplan-Meier 方法评估无复发生存 (RFS) 和总生存 (OS)。时间依赖的受试者工作特征 (ROC) 曲线用于评估重新分类肋骨侵犯病例后对生存预测的额外益处。

结果

171 名患者发生胸壁侵犯（62 名肋骨侵犯，51 名壁层胸膜侵犯 [PL3] 和 58 名软组织侵犯）。发现肋骨浸润是 pT3-4 NSCLC 的 RFS (p = 0.006) 和 OS (p < 0.001) 的独立预后因素。肋骨浸润组的存活率最差（RFS：13.1%；OS：19.8%），其次是 PL3（RFS：34.2%，P = 0.001；OS：48.8%；p < 0.001）和软组织浸润组（ RFS：40.6%，p = 0.001；OS：57.7%，p < 0.001）。此外，肋骨侵犯组的预后也比pT3组（RFS：p < 0.001；OS：p < 0.001）和pT4组（RFS：p = 0.002；OS：p < 0.001）差。PSM后，肋骨侵犯组5年RFS率仍低于pT3和pT4组（p<0.001）；肋骨侵犯的 5 年 OS 率与 pT4 组相似（p = 0. 066) 但低于 pT3 组 (p = 0.014)。时间依赖性 ROC 曲线表明，将肋骨浸润重新分类为 pT4 疾病为生存预测提供了额外的好处（p < 0.001）。

结论

肋骨浸润组的预后比 PL3 和 pT3 组差。肋骨侵犯的预后影响应进一步验证为 TNM 分类中的 pT4 疾病。