title: New dilemmas in small-cell lung cancer TNM clinical staging.
abstract: BACKGROUND
  Many patients with limited disease (LD) behave similarly to those with extensive disease (ED) from a prognostic point of view. On the other hand, a proportion of patients with ED small-cell lung cancer (SCLC) behave similarly to those with LD.
  
  
  METHODS
  In this retrospective study analysis, 764 patients with proven SCLC were included and managed with the same therapeutic protocols. Of these patients, 278 (36.4%) had LD, while 486 (63.6%) had ED.
  
  
  RESULTS
  No statistically significant difference was observed for survival for IA and IB disease stages (P = 0.254) and between IIA and IIB stages (P = 0.256) according to the new tumor, node, metastasis (TNM) staging classification classification. In addition, no statistical significant difference was observed for survival between patients with (IIA + IIB) and IIIA (P = 0.951), (IIA + IIIA, P = 0.658), and (IIB + IIIA, P = 0.573) stages. Statistical significant difference was observed for survival among the LD SCLC patients with (IA + IB), (IIA + IIB + IIIA), and IIIB stages (P < 0.001). Similarly, statistical significance was observed for ED SCLC patients with (IIA + IIB + IIIA), IIIB, and IV stages (P < 0.001).
  
  
  CONCLUSIONS
  Although stratification of SCLC patients in LD and ED is generally satisfactory, the TNM staging system is recommended for more detailed prognostic information and treatment evaluation in these patients.
authors.affiliation: Pulmonary Department-Oncology Unit, "G Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zarogoulidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Latsios
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Porpodis
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.forename: Kaid
authors.initials: K
authors.lastname: Darwiche
authors.forename: Nick
authors.initials: N
authors.lastname: Antoniou
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hohenforst-Schmidt
authors.forename: Ellada
authors.initials: E
authors.lastname: Eleftheriadou
authors.forename: Efimia
authors.initials: E
authors.lastname: Boutsikou
authors.forename: Theodoros
authors.initials: T
authors.lastname: Kontakiotis
keywords: lung cancer; small-cell lung cancer; staging