Proposal to Upgrade Extracapsular Extension of Tumor in Nodes Is Acceptable, Researchers Say

It is reasonable to upgrade extracapsular extension (ECE) of tumor in lymph nodes from R0 to incomplete resection (R1 and R2), according to a recent study led by Huikang Xie.

Xie and colleagues studied thousands of patients with NSCLC in China to determine if there was enough evidence to upstage ECE based on a proposal from the International Association for the Study of Lung Cancer (IASLC).

After reclassification by IASLC of residual tumor (R) classification, patients with ECE were then compared with patients with R0, R(un), and R1 and R2 for OS rates.

The researchers narrowed the study even further to include 1136 patients with N disease. Patients without ECE (67%) had significantly better OS than patients with ECE (33%), and this finding proved to be consistent across multiple subgroups, the researchers said.

In addition, OS was significantly worse for patients with ECE when they were separated from the IASLC-R1 group compared with IASLC-R(un) patients. However, when evaluating all patients and patients with N disease, OS was comparable with the remaining patients in the IASLC-R1 group.

Furthermore, patients with ECE had an increased risk of local recurrence in the mediastinum, ipsilateral lung, and malignant pleural effusion or nodes but not distant recurrence (contralateral or both lungs, liver, brain, or bone).