Validation of a central review board of staging prior to surgery for non-small-cell lung cancer--impact on prognosis: a multicenter study.
BACKGROUND
In non-small-cell lung cancer (NSCLC), the evaluation of anatomic tumor extension [tumor, node, metastasis (TNM) stage] is indispensable for the exchange of scientific information or determining prognosis.


OBJECTIVE
To quantify changes in TNM stages (numerical migration) and survival (prognostic migration) resulting from the application of classificatory certainty criteria to patients with NSCLC who had undergone surgical treatment.


METHODS
The study population included 1,844 patients registered by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). For every patient, two evaluations were made of each component of the TNM classification: an initial classification, defined by a local representative, and a confirmed classification resulting from the application of stricter classificatory criteria by the GCCB-S Central Review Board.


RESULTS
The results revealed scant numerical migration in the cT category (11.5% of the study population) and a general tendency toward a downstaging. In contrast, the initial cN1 category experienced a complete numerical migration and the initial cN2 category a very large numerical migration (from 200 to 22 cases). In the small group of patients for whom there was a classificatory change in cT (n = 212), the migration for the cT2 category was accompanied by a less favorable prognosis (p = 0.039, log-rank test). However, the migration of this small subset of patients did not affect the general prognosis of the study population for cT2. In cN2, the 3-year survival rate migrated from 0.42 to 0.29.


CONCLUSIONS
Numerical migration resulting from the application of stricter classificatory criteria was relevant, but had little, although unfavorable, global prognostic impact.
López-Encuentra
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Pneumology Service, Hospital Universitario 12 de Octubre, Madrid, Spain. lencuent@h12o.es
Goméz De La Cámara
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D001707:Biopsy, Needle; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging / Q000592:standards*; D011300:Preoperative Care; D011379:Prognosis; D012042:Registries; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012955:Societies, Medical; D013030:Spain; D016019:Survival Analysis