Clinical Staging of Stage I Non-Small Cell Lung Cancer in the Netherlands—Need for Improvement in an Era With Expanding Nonsurgical Treatment Options

Data From the Dutch Lung Surgery Audit

Journal article (2016)

Authors

David Jonathan Heineman Medisch Centrum Alkmaar
Martijn Geert ten Berge Leiden University Medical Center
Johannes Marlene Daniels Amsterdam UMC
Michaël Ignatius Versteegh Leiden University Medical Center
P.J. Marang-van de Mheen Leiden University Medical Center
M.W. Wouters Dutch Institute for Clinical Auditing, Antoni van Leeuwenhoek Hospital
Wilhelmina Hendrika Schreurs Medisch Centrum Alkmaar
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Published Date

2016

Language

English

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Abstract

Background The clinical stage of non-small cell lung cancer (NSCLC) determines the initial treatment, whereas the pathologic stage best determines prognosis and the need for adjuvant treatment. In an era in which stereotactic ablative radiotherapy (SABR) has become an alternative modality to surgical intervention, clinical staging is even more important, because pathologic staging is omitted in the case of SABR. The objective of this study was to determine the concordance between clinical and pathologic stage in routine clinical practice for patients with early-stage NSCLC. Methods Prospective data were derived from the Dutch Lung Surgery Audit (DLSA) in 2013 and 2014. Patients with clinical stage I NSCLC who underwent surgical resection and had a positron emission tomography-computed tomography (PET-CT) scan in their clinical workup were selected. Clinical and pathologic TNM (cTNM and pTNM) stages were compared. Results From a total of 1,790 patients with clinical stage I, 1,555 (87%) patients were included in this analysis. Concordance between cTNM and pTNM was 59.9%. Of the patients with clinical stage I, 22.6% were upstaged to pathologic stage II or higher. In total, 14.9% of all patients with clinical stage I had nodal metastases, and 5.5% of all patients had unforeseen N2 disease. In patients with clinical stage T2a tumors, 21.3% had nodal metastases, 14.5% being N1 and 6.7% being N2 disease. Conclusions Concordance between clinical and pathologic stage is 59.9%. In patients with clinical stage I NSCLC, 22.6% were upstaged to pathologic stage II or higher, which is an indication for adjuvant chemotherapy. Improvement in accuracy of staging is thus needed, particularly for these patients.