The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data.
Aged
Antineoplastic Agents
/ therapeutic use
Carcinoma, Non-Small-Cell Lung
/ drug therapy
Female
Humans
Kaplan-Meier Estimate
Lung Neoplasms
/ drug therapy
Male
Middle Aged
Neoplasm Staging
/ methods
Patient Selection
Preoperative Care
/ methods
Prognosis
Reproducibility of Results
Surgical Procedures, Operative
/ methods
meta-analysis
non-small cell lung cancer
staging
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
03 2019
03 2019
Historique:
received:
23
05
2018
revised:
17
08
2018
accepted:
02
10
2018
pubmed:
6
11
2018
medline:
21
12
2019
entrez:
5
11
2018
Statut:
ppublish
Résumé
Clinical staging of non-small cell lung cancer (NSCLC) helps determine the prognosis and treatment of patients; few data exist on the accuracy of clinical staging and the impact on treatment and survival of patients. We assessed whether participant or trial characteristics were associated with clinical staging accuracy as well as impact on survival. We used individual participant data from randomized controlled trials (RCTs), supplied for a meta-analysis of preoperative chemotherapy (± radiotherapy) vs surgery alone (± radiotherapy) in NSCLC. We assessed agreement between clinical TNM (cTNM) stage at randomization and pathologic TNM (pTNM) stage, for participants in the control group. Results are based on 698 patients who received surgery alone (± radiotherapy) with data for cTNM and pTNM stage. Forty-six percent of cases were cTNM stage I, 23% were cTNM stage II, and 31% were cTNM stage IIIa. cTNM stage disagreed with pTNM stage in 48% of cases, with 34% clinically understaged and 14% clinically overstaged. Agreement was not associated with age (P = .12), sex (P = .62), histology (P = .82), staging method (P = .32), or year of randomization (P = .98). Poorer survival in understaged patients was explained by the underlying pTNM stage. Clinical staging failed to detect T4 disease in 10% of cases and misclassified nodal disease in 38%. This study demonstrates suboptimal agreement between clinical and pathologic staging. Discrepancies between clinical and pathologic T and N staging could have led to different treatment decisions in 10% and 38% of cases, respectively. There is therefore a need for further research into improving staging accuracy for patients with stage I-IIIa NSCLC.
Sections du résumé
BACKGROUND
Clinical staging of non-small cell lung cancer (NSCLC) helps determine the prognosis and treatment of patients; few data exist on the accuracy of clinical staging and the impact on treatment and survival of patients. We assessed whether participant or trial characteristics were associated with clinical staging accuracy as well as impact on survival.
METHODS
We used individual participant data from randomized controlled trials (RCTs), supplied for a meta-analysis of preoperative chemotherapy (± radiotherapy) vs surgery alone (± radiotherapy) in NSCLC. We assessed agreement between clinical TNM (cTNM) stage at randomization and pathologic TNM (pTNM) stage, for participants in the control group.
RESULTS
Results are based on 698 patients who received surgery alone (± radiotherapy) with data for cTNM and pTNM stage. Forty-six percent of cases were cTNM stage I, 23% were cTNM stage II, and 31% were cTNM stage IIIa. cTNM stage disagreed with pTNM stage in 48% of cases, with 34% clinically understaged and 14% clinically overstaged. Agreement was not associated with age (P = .12), sex (P = .62), histology (P = .82), staging method (P = .32), or year of randomization (P = .98). Poorer survival in understaged patients was explained by the underlying pTNM stage. Clinical staging failed to detect T4 disease in 10% of cases and misclassified nodal disease in 38%.
CONCLUSIONS
This study demonstrates suboptimal agreement between clinical and pathologic staging. Discrepancies between clinical and pathologic T and N staging could have led to different treatment decisions in 10% and 38% of cases, respectively. There is therefore a need for further research into improving staging accuracy for patients with stage I-IIIa NSCLC.
Identifiants
pubmed: 30391190
pii: S0012-3692(18)32607-2
doi: 10.1016/j.chest.2018.10.020
pmc: PMC6435782
pii:
doi:
Substances chimiques
Antineoplastic Agents
0
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
502-509Subventions
Organisme : Medical Research Council
ID : G0800465
Pays : United Kingdom
Organisme : Medical Research Council
ID : MC_UU_12023/28
Pays : United Kingdom
Organisme : NCI NIH HHS
ID : U10 CA180888
Pays : United States
Organisme : Department of Health
Pays : United Kingdom
Investigateurs
Sarah Burdett
(S)
Larysa H M Rydzewska
(LHM)
Jayne F Tierney
(JF)
Anne Auperin
(A)
Thierry Le Chevalier
(T)
Cécile Le Pechoux
(C)
Jean-Pierre Pignon
(JP)
Rodrigo Arriagada
(R)
David H Johnson
(DH)
Jan van Meerbeeck
(J)
Mahesh K B Parmar
(MKB)
Richard J Stephens
(RJ)
Lesley A Stewart
(LA)
Paul A Bunn
(PA)
Bertrand Dautzenberg
(B)
David Gilligan
(D)
Harry Groen
(H)
Aija Knuuttila
(A)
Eric Vallieres
(E)
Rafael Rosell
(R)
Jack Roth
(J)
Giorgio Scagliotti
(G)
Masahiro Tsuboi
(M)
David Waller
(D)
Virginie Westeel
(V)
Yi-Long Wu
(YL)
Xue-Ning Yang
(XN)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.
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