title: Impact of the new lung cancer staging system for a predominantly advanced-disease patient population.
abstract: BACKGROUND
  To investigate the feasibility and clinical impact of the 7th edition of the "Tumor, Node, Metastasis" (TNM) classification scheme in lung cancer as proposed by the International Association for the Study of Lung Cancer (IASLC) for non-small cell lung cancer.
  
  
  METHODS
  We evaluated the feasibility of the new staging system in our routine biweekly multidisciplinary lung cancer staging conference compared with the 6th TNM staging in a prospective manner from April 2008 to June 2009. The impact of IASLC staging versus the 6th TNM staging was observed at three levels: change in substaging, staging, and clinical management (based on the discussion within the staging conference).
  
  
  RESULTS
  From 348 patients discussed during these conferences, 226 eligible non-small cell lung cancer patients newly diagnosed within the study period were reviewed and clinically staged. The majority were elderly (median age, 67 years) and men (58%). Of these, 23 patients had different staging, and four patients had different substaging in the IASLC staging compared with the 6th TNM staging. An impact on clinical management was seen in 2.7% (6 of 226) of these patients because of coding ipsilateral different-lobe metastasis as T4 instead of M1.
  
  
  CONCLUSIONS
  The new staging system was clinically feasible and resulted in some (27 of 226, 12%) differences in staging. An impact on clinical decision making was occasionally seen within our institutional practice. Further studies are needed to investigate the comprehensive and long-term impact of the new staging system.
authors.affiliation: Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chun-Ru
authors.initials: CR
authors.lastname: Chien
authors.forename: Su-Tso
authors.initials: ST
authors.lastname: Yang
authors.forename: Chih-Yi
authors.initials: CY
authors.lastname: Chen
authors.forename: Hsin-Yuan
authors.initials: HY
authors.lastname: Fang
authors.forename: Chih-Yen
authors.initials: CY
authors.lastname: Tu
authors.forename: Guan-Chin
authors.initials: GC
authors.lastname: Tseng
authors.forename: Yang-Ho
authors.initials: YH
authors.lastname: Yu
authors.forename: Hung-Jen
authors.initials: HJ
authors.lastname: Chen
authors.forename: Chih-Te
authors.initials: CT
authors.lastname: Ho
authors.forename: Ching-Yun
authors.initials: CY
authors.lastname: Hsieh
authors.forename: Hsiang-Ni
authors.initials: HN
authors.lastname: Chen
authors.forename: Pin-Ru
authors.initials: PR
authors.lastname: Chen
authors.forename: Juhn-Cherng
authors.initials: JC
authors.lastname: Liu
authors.forename: Yao-Ching
authors.initials: YC
authors.lastname: Wang
authors.forename: Hui-Hua
authors.initials: HH
authors.lastname: Wu
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Hsia
mesh_terms: D000230:Adenocarcinoma / Q000145:classification / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000145:classification / Q000473:pathology* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate