Accidental invisible intrathoracic disseminated pT4-M1a: a distinct XXXX with favorable prognosis.

@entity1 @entity5 @entity470 @entity2 @entity787 @entity3 @entity4149 @entity420 @entity1349
OBJECTIVE: In the 7(th) edition of the TNM classification of @entity5 , the prognosis for pT4-M1a @entity5 is better than for stage pIIIB. Subgroups of @entity2 @entity1 who underwent incomplete resection (R1/R2) have a favorable prognosis. This study compares the prognosis between cases of invisible local residual disease and intrathoracic disseminated pT4-M1aIV. METHODS: @entity1 characteristics and histological and molecular profiles were retrospectively collected for @entity2 @entity1 who underwent resection intended to be curative but were accidentally incomplete. All @entity1 were divided into either a local residual group or an intrathoracic disseminated pT4M1a group. Progression-free survival (PFS) and @entity1349 ( @entity1349 ) were evaluated by Kaplan-Meier and Cox regression models. RESULTS: In total, 1,483 consecutive @entity2 @entity1 receiving thoracotomies at Guangdong @entity2 Institute were retrospectively analyzed. Fifty-eight @entity1 receiving incomplete resections (R1/R2) were enrolled, including 38 @entity1 with @entity5 (2.6% of all @entity1 ) and 20 @entity1 with disseminated pM1a (1.3%). @entity1 characteristics, and histological and molecular profiles of the two groups were different. Compared to the local residual group, the disseminated pT4-M1a group contained more females (P=0.002), more @entity1 younger than 60 years of age (P=0.028), more non-smokers (P=0.037), more @entity420 (20/20 vs. 20/38, P<0.001), more @entity420 with lepidic pattern (11/20 vs. 4/38, P<0.001), higher @entity787 ( @entity787 ) levels (P=0.06), higher @entity470 ( @entity470 ) mutation rates (16/20 vs. 7/38, P<0.001), a higher R2/R1 resection ratio (P=0.013), a higher advanced stage IV/IIIB ratio (P<0.001), but fewer lymph node @entity3 (P=0.013). Median PFS for the local residual and disseminated pT4-M1a groups was 9.0 and 18.0 months, respectively [95% confidence interval (CI), 5.285-16.715; P =0.099]. Median @entity1349 was 15.0 and 45.0 months, respectively (95% CI, 18.972-39.028; P=0.001). Cox regression analysis revealed that group (local residual vs. disseminated pT4-M1a) was the only independent prognostic factor (P=0.044) for @entity1349 . CONCLUSIONS: Accidental invisible intrathoracic disseminated pT4-M1a may be a distinct @entity2 subtype with a favorable prognosis. The prolonged PFS and @entity1349 might reflect the natural history of this distinct subtype, together with a favorable response to @entity470 @entity4149 kinase inhibitors ( @entity470 -TKI). For asymptomatic and slow-growing accidental pT4-M1a disease, the role of a wait-and-see strategy and the appropriate timing of systemic treatment require further investigation.
