title: [Comparison of clinical and surgico-pathological TNM stage of 2007 lung cancer patients].
abstract: OBJECTIVE
  An accurate clinical TNM staging of lung cancer is essential for the precise determination of the extent of the disease in order that an optimal therapeutic strategy can be planned. This is especially true in patients with marginally resectable tumors. Clinical over-staging of the disease may deny a patient the benefit of surgery, whereas under-staging may oblige a patient to accept a fruitless or even harmful surgery. We aimed to analyze preoperative clinical (c-TNM) and postoperative surgico-pathologic staging (p-TNM) of lung cancer patients in order to evaluate the accuracy of our clinical staging and its implications on the surgical strategy for lung cancer.
  
  
  METHODS
  We did a retrospective comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer surgically treated from January 1999 to May 2003. Preoperative evaluation and c-TNM staging of all patients were based on physical examination, laboratory studies, routine chest X-ray and CT scan of the chest and upper abdomen. Other examinations included sputum cytology, bronchoscopy, abdominal ultrasonography, bone scintiscan, brain CT/MRI, and mediastinoscopy whenever indicated.
  
  
  RESULTS
  In the present study the comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer revealed an overall concurrence rate of only 39.0%. In the entire series the extent of disease was clinically underestimated in 45.2% and overestimated in 15.8% of the patients. Among all c-TNM stages the c-IA/B stage of 1105 patients gave the highest rate (55.2%) of underestimating the extent of disease. Clinical staging of T subsets was relatively easy with an overall accuracy rate of 72.9%, while that of N subsets was relatively more difficult with an overall accuracy rate of 53.5%. Analysis also showed that c-IV stage may not be an absolute contraindication to surgery, because in half of the patients, c-M1 turned out to be p-M0, providing the possibility of resectional surgery depending on the status of T and N.
  
  
  CONCLUSIONS
  For reasons to be further determined, the present preoperative clinical TNM staging of lung cancer remains a crude evaluation. Further efforts to improve its accuracy are needed.
authors.affiliation: Department of Thoracic Surgical Oncology, Cancer Institute, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
authors.forename: Guo-jun
authors.initials: GJ
authors.lastname: Huang
authors.forename: De-chao
authors.initials: DC
authors.lastname: Zhang
authors.forename: You-sheng
authors.initials: YS
authors.lastname: Mao
authors.forename: Jian
authors.initials: J
authors.lastname: Li
authors.forename: Yong-gang
authors.initials: YG
authors.lastname: Wang
authors.forename: Da-li
authors.initials: DL
authors.lastname: Wang
authors.forename: Qi
authors.initials: Q
authors.lastname: Xue
authors.forename: Shu-geng
authors.initials: SG
authors.lastname: Gao
authors.forename: Liang-ze
authors.initials: LZ
authors.lastname: Zhang
authors.forename: Wen-dong
authors.initials: WD
authors.lastname: Lei
authors.forename: Yu-shun
authors.initials: YS
authors.lastname: Gao
authors.forename: Jun
authors.initials: J
authors.lastname: Zhao
authors.forename: Jin-feng
authors.initials: JF
authors.lastname: Huang
authors.forename: Kun
authors.initials: K
authors.lastname: Yang
authors.forename: Kai
authors.initials: K
authors.lastname: Su
authors.forename: Shou-ying
authors.initials: SY
authors.lastname: Zhu
authors.forename: Sen
authors.initials: S
authors.lastname: Wei
authors.forename: Fei-yue
authors.initials: FY
authors.lastname: Feng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D012189:Retrospective Studies