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.
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.
Department of Surgery, Medisch Centrum Alkmaar, Alkmaar, the Netherlands. Electronic address: david.heineman@gmail.com.
David Jonathan
DJ
Heineman
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Martijn Geert
MG
Ten Berge
Department of Pulmonary Diseases, VU University Medical Centre, Amsterdam, the Netherlands.
Johannes Marlene
JM
Daniels
Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Michaël Ignatius
MI
Versteegh
Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands.
Perla Jacqueline
PJ
Marang-van de Mheen
Department of Surgical Oncology, Antoni van Leeuwenhoek Hospital/Netherlands Cancer Institute, Amsterdam, the Netherlands; Scientific Bureau, Dutch Institute for Clinical Auditing, Leiden, the Netherlands.
Michael Wilhelmus
MW
Wouters
Department of Surgery, Medisch Centrum Alkmaar, Alkmaar, the Netherlands.
Wilhelmina Hendrika
WH
Schreurs
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis* / Q000628:therapy; D054869:Clinical Audit / Q000706:statistics & numerical data*; D003131:Combined Modality Therapy / Q000592:standards / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D009367:Neoplasm Staging; D009426:Netherlands; D011013:Pneumonectomy / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography; D011379:Prognosis; D058996:Quality Improvement; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed