Validation of the 8th lung cancer TNM classification and clinical staging system in a German cohort of surgically resected patients

Abstract

ObjectivesThe updated 8th edition of the tumor, node, metastases (TNM) classification system for non-small cell lung cancer (NSCLC) attempts to improve on the previous 7th edition in predicting outcomes and guiding management decisions. This study sought to determine whether the 8th edition was more accurate in predicting long-term survival in a European population of surgically treated NSCLC patients.MethodsWe scanned the archives of the Heckeshorn Lung Clinic for patients with preoperative clinical stages of IIIA or lower (based on the 7th edition), who received surgery for NSCLC between 2009 and 2014. We used pathologists’ reports and data on tumor size and location to reassign tumor stages according to the 8th edition. We then analyzed stage specific survival and compared the accuracy of the two systems in predicting long-term survival. We excluded patients with neoadjuvant treatment, incomplete follow-up data, tumor histologies other than NSCLC, or death within 30 days of surgery.ResultsThe final analysis included 1,013 patients. Overall five-year survival was 47.3%. The median overall survival (OS) was 63 months (range 1–222), and the median disease-free survival (DFS) was 50 months (0–122). The median follow-up time for non-censored patients was 84 months (range 60–122).ConclusionsWe found significant survival differences between the newly defined stages 1A1, 1A2 and 1A3 (previously 1A). We also found that the 8th edition of TMN classification was a significantly better predictor of long-term survival, compared to the 7th edition.

Real-life long-term outcomes of upfront surgery in patients with resectable stage I-IIIA non-small cell lung cancer

“…Our data exceed the median OS of 63 months observed in a German cohort of patients with radically resected stage I–IIIB NSCLC, treated at a single academic centre in a very similar period (from 2009 to 2014), which also included patients with a higher stage IIIB disease. 10 When comparing by pTNM stage I, II and IIIA, the estimated 5-year survival rates of 70.2%, 60.2% and 49.9%, respectively, observed in our study, correspond very well to the 5-year survival rates in the German study. 10 Our findings also slightly exceed the 5-year survival rates of 83%–71%, 57%–49% and 36% for pTNM stage IA–B, II A–B and IIIA, published by IASLC.…”

“… 10 When comparing by pTNM stage I, II and IIIA, the estimated 5-year survival rates of 70.2%, 60.2% and 49.9%, respectively, observed in our study, correspond very well to the 5-year survival rates in the German study. 10 Our findings also slightly exceed the 5-year survival rates of 83%–71%, 57%–49% and 36% for pTNM stage IA–B, II A–B and IIIA, published by IASLC. 9 Furthermore, our findings are also in line with 5-year survival rates between 37%–47%, observed in real-life cohorts of patients with resectable stage IIIA–N2 NSCLC, treated with upfront surgery in a similar period.…”

“…To better predict and evaluate the effectiveness of those novel strategies in everyday clinical practice and to develop individualized risk-adjusted treatment strategies for individual patients, more data on clinicopathological characteristics and outcomes of early-stage NSCLC patients treated in a real-life before the introduction of those novelties, are needed. The International Association for the Study of Lung Cancer (IASLC) recommendations for TNM classification scheme, based on a database of nearly 90.000 patients 9 as well as some IASCL validation studies performed on the Caucasian population 10 provide valuable data on survival of patients treated in routine clinical practice. Next to the IASLC data, there is almost complete lack of information on the outcomes of the cohorts of resectable stage I–IIIA NSCLC patients, treated in a real-life scenario in the last decade.…”

Clinicopathological significance of peritumoral alveolar macrophages in patients with resected early-stage lung squamous cell carcinoma

“…The standard therapy for stage I lung cancer is surgery [2]. However, some lung cancer patients show recurrence after surgery, and the 5-year survival rate after surgery in stage I non-small cell lung cancer (NSCLC) is 57.1-73.5% [3].…”