• Brooks V Udelsman, Christina K Bedrosian, Eric S Kawaguchi, Li Ding, Williams D Wallace, Graeme Rosenberg, Takashi Harano, Sean Wightman, Scott Atay, Anthony W Kim, and Gavitt Woodard.
• Surgery, Keck School of Medicine of USC, Los Angeles, Calif; Keck School of Medicine of USC, Los Angeles, Calif. Electronic address: brooks.udelsman@med.usc.edu.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 7.

ObjectivesTo evaluate the use of systemic therapy and overall survival in patients with resected non-small cell lung cancer whose pathologic tumor size was within 2 mm of a T-stage cutoff.MethodsThis was retrospective cohort study using the National Cancer Database of patients who underwent resection of tumors within 2 mm of the T1c/T2a, T2a/T2b, and T2b/T3 T-stage cutoffs. Patients with nodal involvement or whose T stage was determined on the basis of pathologic features other than tumor size were excluded. A multistate model compared the primary outcomes of systemic therapy and overall survival.ResultsFrom the National Cancer Database, 18,490 patients were identified: 9966 at the T1c/T2a cutoff, 5593 at the T2a/T2b cutoff, and 2931 at the T2b/T3 cutoff. Peaks in tumor size distribution occurred at 5-mm intervals. On the basis of an expected normalized curve, 2050 patients (11.1%) may have been understaged. Use of systemic therapy was greater among patients with larger tumors at the T1c/T2a cutoff (7.1% vs 8.9%; P < .001), the T2a/T2b cutoff (20.0% vs 25.5%; P < .001), and the T2b/T3 cutoff (31.2% vs 41.8%; P < .001). In a multistate model, mortality was greater above the T1c/T2a cutoff (hazard ratio [HR], 1.10; P = .01), T2a/T2b cutoff (HR, 1.17; P < .01), and T2b/T3 cutoff (HR, 1.13; P = .03). In patients who received systemic therapy, this trend was eliminated (HR, 1.24; P = .14, HR, 0.79; P = .07, and HR, 1.23; P = .09, respectively).ConclusionsRounding of tumor size for pathologic staging is common. Although seemingly trivial, rounding may downstage patients and is associated with decreased rates of adjuvant therapy use and potentially worse overall survival.Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

6 keywords...

hide…