Application of the revised lung cancer staging system (IASLC Staging Project) to a cancer center population

Background: Lung cancer is the leading cause of cancer related morbidity and mortality accounting for 15.4 % of total cancer in Nepal. With revision of the Lung cancer staging system by International Association for the Study of Lung Cancerand adoption of seventh edition of staging system by American Joint Committee on Cancer in 2010, the application of seventh edition of staging system has significant impact on stage of disease which ultimately defines treatment strategyand overall prognosis.Objective: To improve stage precision by adapting new staging system, this will directly refl ect on disease treatment, survival and prognosis.Methodology: Medical records of 151 patients with lung cancer attending Oncology Department, between 2015 and 2016 were retrospectively reclassified using both sixth and seventh editions of staging system. Data were collected compared and managed using Statistical Package for Social Sciences. Ethical clearance was obtained from Institutional Review Board.Results: Stage migration was seen in 15.23 % of total cases. Seven percent of cases staged down from IIIB to IIIA. Four percent were staged up from IIIB to IV. Remaining were down staged from T4 to T3 and T3 to T2 due to sub categorization of tumor by size in seventh edition.Conclusions: There was downstage from IIIB to IIIA and upstage from IIIB to IV because of revised staging system. Thus, it is essential to have detailed radiological staging and routine pleural fluid cytology before initiation of treatment, which will further help to stage accurately and treat properly. This carries direct impact on prognosis and survival. Journal of Kathmandu Medical College,Vol. 7, No. 2, Issue 24, Apr.-Jun., 2018, Page: 55-58

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Lack of apparent difference in outcome between clinically staged IIIA and IIIB non-small-cell lung cancer treated with radiation therapy.

Journal of Clinical Oncology ◽

10.1200/jco.1990.8.3.409 ◽

1990 ◽

Vol 8 (3) ◽

pp. 409-415 ◽

Cited By ~ 57

Author(s):

W J Curran ◽

P M Stafford

Keyword(s):

Lung Cancer ◽

Radiation Therapy ◽

Performance Status ◽

Staging System ◽

Large Cell ◽

Stage Iii ◽

Cancer Center ◽

Apparent Difference ◽

Ajcc Staging System ◽

Ajcc Staging

The current American Joint Committee on Cancer (AJCC) staging system for bronchogenic carcinoma, which divides stage III M0 cases into stages IIIA and IIIB, is based on the observation that selected patients with IIIA disease (T3 or N2) can undergo complete surgical resection, in distinction to IIIB patients (T4 or N3). To understand the value of this system when applied to clinically staged (CS) patients treated with a standard nonoperative approach, the records of patients with squamous cell, large-cell, and adenocarcinoma of the lung treated with radiation therapy (RT) at the Fox Chase Cancer Center from 1978 to 1987 were reviewed. Three hundred sixteen patients were identified as having CS III M0 disease treated with single daily fraction RT without chemotherapy or sensitizers. Of these, the distinction between IIIA (166) and IIIB (140) could be made for 306 patients. The median survival time (MST) for all CS III patients was 9.6 months, and the 2-year survival was 17%. No difference was observed in MST between CS IIIA and IIIB patients (9.4 v 9.8 months, P = .78), in 2-year survival (17% v 18%), or in rate of first failure within the RT field (43% v 44%). MSTs for the 157 CS IIIA and IIIB patients with less than 5% weight loss and Zubrod performance status (PS) 0 to 1 were 13.0 and 15.8 months (P = .29), respectively. This lack of difference in outcome for CS IIIA and IIIB patients receiving RT has important implications in the design and stratification of future nonoperative trials for stage III lung cancer.

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The “N”—factor in non-small cell lung cancer: staging system and institutional reports

Journal of Thoracic Disease ◽

10.21037/jtd.2016.11.37 ◽

2016 ◽

Vol 8 (11) ◽

pp. 3049-3052

Author(s):

Ottavio Rena

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Staging System ◽

Cancer Staging ◽

Small Cell ◽

Small Cell Lung

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Commonly Encountered Difficulties in Pathologic Staging of Lung Cancer

Archives of Pathology & Laboratory Medicine ◽

10.5858/2007-131-1016-cedips ◽

2007 ◽

Vol 131 (7) ◽

pp. 1016-1026

Author(s):

Douglas B. Flieder

Keyword(s):

Lung Cancer ◽

Mediastinal Lymph Node ◽

Staging System ◽

Cancer Staging ◽

Tnm Staging ◽

Term Survival ◽

Lymph Node Sampling ◽

Incurable Disease ◽

Therapeutic Decisions ◽

Tnm Staging System

Abstract Context.—Lung cancer is the leading cause of cancer mortality worldwide. Despite technological, therapeutic, and scientific advances, most patients present with incurable disease and a poor chance of long-term survival. For those with potentially curable disease, lung cancer staging greatly influences therapeutic decisions. Therefore, surgical pathologists determine many facets of lung cancer patient care. Objective.—To present the current lung cancer staging system and examine the importance of mediastinal lymph node sampling, and also to discuss particularly confusing and/or challenging areas in lung cancer staging, including assessment of visceral pleura invasion, bronchial and carinal involvement, and the staging of synchronous carcinomas. Data Sources.—Published current and prior staging manuals from the American Joint Committee on Cancer and the International Union Against Cancer as well as selected articles pertaining to lung cancer staging and diagnosis accessible through PubMed (National Library of Medicine) form the basis of this review. Conclusions.—Proper lung cancer staging requires more than a superficial appreciation of the staging system. Clinically relevant specimen gross examination and histologic review depend on a thorough understanding of the staging guidelines. Common sense is also required when one is confronted with a tumor specimen that defies easy assignment to the TNM staging system.

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The New Lung Cancer Staging System

Yearbook of Diagnostic Radiology ◽

10.1016/s0098-1672(09)79086-1 ◽

2010 ◽

Vol 2010 ◽

pp. 5-7

Author(s):

M.L. Rosado de Christenson

Keyword(s):

Lung Cancer ◽

Staging System ◽

Cancer Staging

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Validation of Prognostic Stage and Anatomic Stage in the American Joint Committee on Cancer 8th Edition for Inflammatory Breast Cancer

Cancers ◽

10.3390/cancers12113105 ◽

2020 ◽

Vol 12 (11) ◽

pp. 3105

Author(s):

Kumiko Kida ◽

Kenneth R. Hess ◽

Bora Lim ◽

Toshiaki Iwase ◽

Sudpreeda Chainitikun ◽

...

Keyword(s):

Breast Cancer ◽

Inflammatory Breast Cancer ◽

Growth Factor Receptor ◽

Disease Free Survival ◽

Staging System ◽

Cancer Staging ◽

Cancer Center ◽

Cancer Specific Survival ◽

Breast Cancer Staging ◽

Grade 3

The AJCC updated its breast cancer staging system to incorporate biological factors in the “prognostic stage”. We undertook this study to validate the prognostic and anatomic stages for inflammatory breast cancer (IBC). We established two cohorts of IBC diagnosed without distant metastasis: (1) patients treated at The University of Texas MD Anderson Cancer Center between 1991 and 2017 (MDA cohort) and (2) patients registered in the national Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 (SEER cohort). For prognostic staging, estrogen receptor (ER)+/progesterone receptor (PR)+/ human epidermal growth factor receptor-2 (HER2)+/grade 1–2 was staged as IIIA; ER+/PR−/HER2−/grade 3, ER−/PR+/HER2−/grade 3, and triple-negative cancers as IIIC; and all others as IIIB. Endpoints were breast cancer-specific survival (BCSS), overall survival (OS), and disease-free survival (DFS). We studied 885 patients in the MDA cohort and 338 in the SEER cohort. In the MDA cohort, the prognostic stage showed significant predictive power for BCSS, OS, and DFS (all p < 0.0001), although the anatomic stage did not. In both cohorts, the Harrell concordance index (C index) was significantly higher in the prognostic stage than the anatomic stage for all endpoints. In conclusion, the prognostic stage provided more accurate prognostication for IBC than the anatomic stage. Our results show that the prognostic staging is applicable in IBC.

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