Abstract Introduction The International Association for the Study of Lung Cancer's (IASLC's) proposal to recategorize the residual tumor (R) classification for resected NSCLC needs validation. Methods Using a 2009 to 2019 population-based multi-institutional NSCLC resection cohort from the United States, we classified resections by Union for International Cancer Control (UICC) and IASLC R criteria and compared the distribution of R classification variables and their survival associations. Results Of 3361 resections, 95.3% were R0, 4.3% were R1, and 0.4% were R2 by UICC criteria; 33.3% were R0, 60.8% were R-uncertain, and 5.8% were R1/2 by IASLC criteria; 2044 patients (63.8%) migrated from UICC R0 to IASLC R-uncertain. Median survival was not reached, 69 (95% confidence interval [CI]: 64–77), and 25 (95% CI: 18–36) months, respectively, for patients with IASLC R0, R-uncertain, and R1 or R2 resections. Failure to achieve nodal dissection criteria caused 98% of migration to R-uncertainty, metastasis to the highest mediastinal node station, 5.8%. Compared with R0, R-uncertain resections with mediastinal nodes, no mediastinal nodes, and no nodes had adjusted hazard ratios of 1.28 (95% CI: 1.10–1.48), 1.47 (95% CI: 1.24–1.74), and 1.74 (95% CI: 1.37–2.21), respectively, suggesting a dose-response relationship between nodal R-uncertainty and survival. Accounting for mediastinal nodal involvement, the highest mediastinal station involvement was not independently prognostic. The incomplete resection variables were uniformly prognostic. Conclusions The proposed R classification recategorization variables were mostly prognostic, except the highest mediastinal nodal station involvement. Further categorization of R-uncertainty by severity of nodal quality deficit should be considered.

中文翻译：

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超限状态：提议的 IASLC 残留肿瘤分类重新分类的基于人群的验证

摘要 介绍 国际肺癌研究协会 (IASLC) 对已切除 NSCLC 的残留肿瘤 (R) 分类重新分类的提案需要验证。方法 使用来自美国的 2009 年至 2019 年基于人群的多机构 NSCLC 切除队列，我们​​根据国际癌症控制联盟 (UICC) 和 IASLC R 标准对切除术进行分类，并比较 R 分类变量的分布及其生存关联。结果 3361例手术中，UICC标准95.3%为R0，4.3%为R1，0.4%为R2；根据IASLC标准，33.3%为R0，60.8%为R-不确定，5.8%为R1/2；2044 名患者 (63.8%) 从 UICC R0 迁移到 IASLC R-不确定。中位生存期未达到，分别为 69（95% 置信区间 [CI]：64-77）和 25（95% CI：18-36）个月，对于 IASLC R0、R 不确定和 R1 或 R2 切除的患者。未能达到淋巴结清扫标准导致 98% 的迁移到 R 不确定性，转移到最高纵隔淋巴结站，5.8%。与 R0 相比，R-不确定切除纵隔淋巴结、无纵隔淋巴结和无淋巴结的调整后风险比为 1.28（95% CI：1.10-1.48）、1.47（95% CI：1.24-1.74）和 1.74（95 % CI：1.37–2.21)，分别表明节点 R 不确定性和存活率之间存在剂量反应关系。考虑到纵隔淋巴结受累，最高的纵隔站受累不是独立的预后。不完全切除变量是一致的预后。结论 建议的 R 分类重新分类变量主要是预后，除了最高纵隔淋巴结受累。