Comparison of clinical and surgical-pathologic staging of the patients with non-small cell lung carcinoma

Çetınkaya, Erdoğan; Turna, Akif; Yıldız, Pınar; Dodurgali, Recep; Bedirhan, Mehmet Ali; Gürses, Atilla; Yılmaz, Veysel

doi:10.1016/s1010-7940(02)00581-x

Cited by 53 publications

(40 citation statements)

References 18 publications

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“…In contrast, T-staging is more commonly clinically overstaged than understaged. In a recent study examining this aspect specifically, Cetinkaya et al (5) found that T 4 tumors were overstaged 26% of the time, compared with 12% understaging (and correct only 62% of the time). Even more dramatic was the incidence of overstaging of clinical T 4 tumors in 38% of cases, with the clinical implication two out of five potentially curable patients would not have been considered for surgical resection.…”

Section: Stagingt 3 and T 4 Lung Cancermentioning

confidence: 99%

Surgical Management of T3 and T4 Lung Cancer

DiPerna

Wood

2005

Clinical Cancer Research

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Locally advanced lung cancer (T 3 or T 4 ) has a significantly worse prognosis than lower stage disease. However, this diagnosis is usually made radiologically, and experienced thoracic surgeons are familiar with the low radiologic to pathologic correlation in tumors that abut the great vessels, mediastinum, or chest wall. Commonly these tumors do not directly invade adjacent structures and are, in fact,T 1 orT 2 tumors that are resectable through standard techniques. Where there is no clearly evident invasion of unresectable structures, the patient should be given the benefit of the doubt and considered at a lower (resectable) stage until proven otherwise. The curability of T 3 tumors varies according to the involved site. A T 3 N 0 tumor involving the chest wall provides the most favorable prognosis among the resected T 3 lesions, with a 5-year survival of >50% in lymph node^negative patients if resection is complete. Palliative incomplete resections of T 4 disease, in which tumor has invaded mediastinal structures, have not shown any survival benefit and are associated with very high morbidity and mortality. However, patients with limited invasion of the carina, left atrium, superior vena cava, or pulmonary artery may be able to be completely resected despite their T 4 classification. Surgical resection remains an important part of the therapy for patients with locally advanced lung cancer. Modern techniques of chest wall resection and reconstruction and bronchoplastic procedures allow complete resection of locally advanced tumors with favorable 5-year survival rates and low morbidity and mortality.

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Section: Stagingt 3 and T 4 Lung Cancermentioning

confidence: 99%

Surgical Management of T3 and T4 Lung Cancer

DiPerna

Wood

2005

Clinical Cancer Research

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“…Clinical staging in patients with NSCLC was based on radiologic, bronchoscopic and other preoperative Wndings, and overstaging or understaging may occur compared to the Wnal surgical-pathologic evaluation (Cetinkaya et al 2002;Yamazaki et al 2007). In this study, no patient with pathologic stage M was found, and only patients with T1 were recruited so that we could exclude the interference to prognosis for the migrations of T stage and focus on N status and methods of mediastinal lymph node dissection.…”

Section: Discussionmentioning

confidence: 99%

Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer

Dong

et al. 2008

J Cancer Res Clin Oncol

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“…Another group of authors, (12) by means of a retrospective analysis of 180 patients with NSCLC submitted to surgical treatment between 1994 and 2000, in whom cervical mediastinoscopy was performed only in the presence of lymph nodes greater than 1 cm in diameter, found that the concordance between CS and PS was 77% for stage the presence of mediastinal lymph node metastasis in 42% of the patients in whom chest CT findings were normal. Endoscopic ultrasonography, a procedure that has been introduced in the evaluation of patients with pulmonary neoplasia, has contributed to better CS evaluation.…”

Section: Discussionmentioning

confidence: 99%

Concordância entre os estadiamentos clínico e patológico em pacientes com câncer de pulmão não-pequenas células, estádios I e II, submetidos a tratamento cirúrgico

et al. 2007

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Objective: To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. Methods: Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. Results: Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. Conclusions: The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.

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Comparison of clinical and surgical-pathologic staging of the patients with non-small cell lung carcinoma

Abstract: Construction of cTNM stage remains a crude evaluation, preoperative mediastinoscopy in every patient must be performed. Preoperative limited T4 disease is not to deny surgery to patients since a considerable number of patients with cT4 are to be understaged following surgery.

Cited by 53 publications

References 18 publications

Surgical Management of T3 and T4 Lung Cancer

Surgical Management of T3 and T4 Lung Cancer

Radical systematic mediastinal lymphadenectomy versus mediastinal lymph node sampling in patients with clinical stage IA and pathological stage T1 non-small cell lung cancer

Concordância entre os estadiamentos clínico e patológico em pacientes com câncer de pulmão não-pequenas células, estádios I e II, submetidos a tratamento cirúrgico

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