Pathological T3 Non-Small Cell Lung Cancer with satellite nodules: number or size, what does matter?

Background Non-small Cell Lung Cancer (NSCLC) with intralobar satellite nodule are defined as T3 (T3SN). We investigated the main features of these tumors and analyzed their impact on Overall Survival (OS). Methods This was a retrospective multicentric study including all pT3SN NSCLC operated on between 2005 and 2020, excluding patients with multifocal ground-glass opacities; who received induction therapies; N3 or stage IV. The diameter of largest (LgN) and smallest nodule (SmN), the total diameter (sum of diameter of all nodules, TS), and the number of SN were measured. Results Among 102 patients, 64.7% were male. 84.3% of patients had one SN (84.3%), 9.8% two SN while 5.9% more than 2 SN. 63 patients were pN0. LgN (p=0.001), SN (p=0.005) and TS (p=0.014) were significantly related to lymph-node metastasis; the LgN and TS were related to visceral pleural invasion (p<0.001)..Five-year OS was 65.1%; at univariable analysis more than 2 satellite nodules, LgN and TS were significantly related to worse OS; at multivariable analysis, TS (Hazard Ratio [HR] 1.116 95% Confidence Interval [CI] 1.008-1.235, p=0.034) was an independent prognostic factors for OS. No significant prognostic factors were found for DFS at multivariable analysis.In pN0 patients, LgN (HR 1.051, 95% CI 1.066-1.099, p=0.027) and non-adenocarcinoma (HR 5.315 CI 95% 1.494-18.910, p=0.010) influenced OS Conclusions Tumor size is related to tumor’s local invasiveness. TS is an independent prognostic factor for OS. Patients with more than 2 SN seem to be at higher risk for death and recurrence.