title: Features and prognostic factors of large node-negative non-small-cell lung cancers shifted to stage II.
abstract: BACKGROUND
  During the period that randomized clinical trials were establishing the role of adjuvant therapy in tumors larger than 5 cm without lymph-node invasion, which shifted from stage IB (6th TNM) to stage II (7th TNM), we derived the rate of shifted patients in our series and analyzed the relationship between specific patient- and tumor- characteristics, and clinical outcome, to identify putative prognostic factors.
  
  
  METHODS
  We retrospectively collected data (age, sex, smoking status, type of surgery grading, and histological type) from 467 patients who underwent radical surgery for primary 6th TNM-T2N0 non-small cell lung cancer patients between 1998 and 2009 at our institute. Categorical variables were cross-tabulated by tumor staging according to the 7th TNM edition, and they were tested both for association with stage and survival.
  
  
  RESULTS
  One hundred and eighteen patients shifted to stage II, mainly older patients and patients with a sarcomatoid or a poorly differentiated carcinoma. Median overall survival time was significantly different across stages. Among the factors investigated, only the tumor dimension resulted in being statistically significant in multivariate analysis.
  
  
  CONCLUSIONS
  Nearly a quarter of patients shifted from stage I (6th TNM) to stage II (7th TNM), raising a major need for information on the effects of adjuvant chemotherapy in this group of patients. Our findings suggest that randomized clinical trials aimed at addressing this topic should consider only tumor dimensions as principal selection criteria.
authors.affiliation: Medical Oncology Unit of Respiratory Tract and Sarcomas, New Drug Development Division, European Institute of Oncology, Milan, Italy. francesca.toffalorio@ieo.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Toffalorio
authors.forename: Davide
authors.initials: D
authors.lastname: Radice
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.forename: Valentina
authors.initials: V
authors.lastname: Sinno
authors.forename: Massimo
authors.initials: M
authors.lastname: Barberis
authors.forename: Gianluca
authors.initials: G
authors.lastname: Spitaleri
authors.forename: Monica
authors.initials: M
authors.lastname: Giovannini
authors.forename: Angelo
authors.initials: A
authors.lastname: Delmonte
authors.forename: Chiara
authors.initials: C
authors.lastname: Catania
authors.forename: Cristina
authors.initials: C
authors.lastname: Noberasco
authors.forename: Daniela
authors.initials: D
authors.lastname: Brambilla
authors.forename: Filippo
authors.initials: F
authors.lastname: de Braud
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Solli
authors.forename: Tommaso
authors.initials: T
authors.lastname: De Pas
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D002296:Carcinosarcoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate