The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands: Data From the Dutch Lung Surgery Audit.
BACKGROUND
Clinical staging of non-small cell lung cancer (NSCLC) determines the initial treatment offered to a patient. The similarity between clinical and pathologic staging in some studies is as low as 50%, and others publish results as high as 91%. The Dutch Lung Surgery Audit is a clinical database that registers the clinical and pathologic TNM of almost all NSCLC patients who undergo operations in the Netherlands. The objective of this study was to determine the accuracy of clinical staging of NSCLC.


METHODS
Prospective data were derived from the Dutch Lung Surgery Audit in 2013 and 2014. Patients were included if they had undergone a surgical resection for stage IA to IIIB NSCLC without neoadjuvant treatment and had a positron emission tomography-computed tomography scan as part of the clinical workup. Clinical (c)TNM and pathologic (p)TNM were compared, and whether discrepancy was based on tumor or nodal staging was determined.


RESULTS
From 2,834 patients identified, 2,336 (82.4%) fulfilled the inclusion criteria and had complete data. Of these 2,336, 1,276 (54.6%) were staged accurately, 707 (30.3%) were clinically understaged, and 353 (15.1%) were clinically overstaged. In the understaged group, 346 patients had a higher pN stage (14.8%), of which 148 patients had unforeseen N2 disease (6.3%). In the overstaged group, 133 patients had a cN that was higher than the pN (5.7%).


CONCLUSIONS
Accuracy of NSCLC staging in the Netherlands is low (54.6%), even in the era of positron emission tomography-computed tomography. Especially accurate nodal staging remains challenging. Future efforts should include the identification of specific pitfalls in NSCLC staging.
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* / Q000601:surgery; D054869:Clinical Audit / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging / Q000592:standards*; D009426:Netherlands; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography; D011785:Quality Assurance, Health Care; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed