John G. Edwards, Kari Chansky, Paul Van Schil, Andrew G. Nicholson, Souheil Boubia, Elisabeth Brambilla, Jessica Donington, Françoise Galateau-Sallé, Hans Hoffmann, Maurizio Infante, Mirella Marino, Edith M. Marom, Jun Nakajima, Marcin Ostrowski, William D. Travis, Ming-Sound Tsao, Yasushi Yatabe, Dorothy J. Giroux, Lynn Shemanski, John Crowley, Marc Krasnik, Hisao Asamura, Ramón Rami-Porta, Valerie Rusch, Luiz Henrique Araujo, David Beer, Pietro Bertoglio, Ricardo Beyruti, Andrea Bille, Vanessa Bolejack, James D. Brierley, A.K. Cangir, David Carbone, Gail Darling, Frank Detterbeck, Xavier Benoit D’Journo, Jessica Donnington, Wilfried Eberhardt, John Edwards, Jeremy Erasmus, Conrad Falkson, Wentao Fang, Dean Fennell, Kwun Fong, Françoise Galateau-Salle, Oliver Gautschi, Ritu Gill, Dorothy Giroux, Meredith Giuliani, Jin Mo Goo, Seiki Hasegawa, Fred Hirsch, Hans Hoffman, Wayne Hofstetter, James Huang, Philippe Joubert, Kemp Kernstine, Keith Kerr, Young Tae Kim, Hong Kwan Kim, Hedy Kindler, Yolande Lievens, Hui Liu, Donald E. Low, Gustavo Lyons, Heber MacMahon, Edith Marom, José-María Matilla, Jan van Meerbeeck, Luis M. Montuenga, Andrew Nicholson, Katie Nishimura, Anna Nowak, Isabelle Opitz, Meinoshin Okumura, Raymond U. Osarogiagbon, Harvey Pass, Marc de Perrot, Helmut Prosch, David Rice, Andreas Rimner, Enrico Ruffini, Shuji Sakai, Navneet Singh, Amy Stoll-D’Astice, Francisco Su´rez, Ricardo M. Terra, Ming S. Tsao, Paula Ugalde, David Waller, Shun-ichi Watanabe, Jacinta Wiens, Ignacio Wistuba, Liyan Jiang, Kaoru Kubota, Akif Turna, Benny Weksler, Maria Teresa Tzukazan, Martin Tammemägi, Charles Powell, David Naidich, Hongxu Liu, Samuel Armato, Alex Brunelli, Giuseppe Cardillo, Elizabeth David, Brigitte Fournier, Mark Krasnik, Kauro Kubota, Catherine Labbe, Eric Lim, Paul Martin Putora, Gaetano Rocco, Pier Luigi Filosso, Kazuya Kondo, Dong Kwan Kim, Giuseppe Giaccone, Marco Lucchi, Thomas Rice, Mark Ferguson, Prasad Adsusmilli, William Travis, Francisco Suárez, Kaura Kubota, Hisao Asamura Shun-ichi, Watanabe, Edith Marom Ramón, Rami-Porta, Ming Tsao, Ming Tsao Shun-ichi, Watanabe, Meredith Guiliani, James Brierley, Ricardo Terra, Ray Osarogiagbon, Luis Montuenga, Hongwei Wang, Françoise Galateau, Jim Mo Goo, Bill Travis, Jose Maria Matilla, Carolle St. Pierre, Ma Teresa Tzukazan, Nicholas Girard, Andreas Rimmer, Francoise Galateau, Prasad Adusumilli, Xavier D’Journo, Donald Low, Adam Rosenthal, and Int Assoc Study Lung Canc Staging
Objective: Our aim was to validate the prognostic relevance in NSCLC of potential residual tumor (R) descriptors, including the proposed International Association for the Study of Lung Cancer definition for uncertain resection, referred to as R(un). Methods: A total of 14,712 patients undergoing resection with full R status and survival were analyzed. The following were also evaluated: whether fewer than three N2 stations were explored, lobe-specific nodal dissection, extracapsular extension, highest lymph node station status, carcinoma in situ at the bronchial resection margin, and pleural lavage cytologic examination result. Revised categories of R0, R(un), R1, and R2 were tested for survival impact. Results: In all, 14,293 cases were R0, 263 were R1, and 156 were R2 (median survivals not reached, 33 months, and 29 months, respectively). R status correlated with T and N categories. A total of 9290 cases (63%) had three or more N2 stations explored and 6641 cases (45%) had lobespecific nodal dissection, correlated with increasing pN2. Extracapsular extension was present in 62 of 364 cases with available data (17%). The highest station was positive in 942 cases (6.4%). The pleural lavage cytologic examination result was positive in 59 of 1705 cases (3.5%): 13 had carcinoma in situ at the bronchial resection margin. After reassignment because of inadequate nodal staging in 56% of cases, 6070 cases were R0, 8185 were R(un), 301 were R1, and 156 were R2. In node-positive cases, the median survival times were 70, 50, and 30 months for RO, R(un) (p < 0.0001), and R1 (p < 0.001), respectively, with no significant difference between RO and R(un) in pN0 cases. Conclusions: R descriptors have prognostic relevance, with R(un) survival stratifying between R0 and R1. Therefore, a detailed evaluation of R factor is of particular importance in the design and analyses of clinical trials of adjuvant therapies. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.