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Application of the revised lung cancer staging system to a cancer center population
The Journal of Thoracic and Cardiovascular Surgery, 06/03/09

Kassis ES et al. - In a study to compare staging systems in pts undergoing surgery for non–small cell lung cancer (NSCLC) to determine whether 1 system is superior in staging operable disease, data confirm that the proposed International Association for the Study of Lung Cancer (IASLC) staging system is more effective at differentiating stage than the Union Internationale Contre le Cancer (UICC-6) system. Reclassifying pts from UICC-6 IIIB to IASLC IIIA will shift some pts from a stage previously considered unresectable to a stage frequently offered surgical resection.

Methods

Pathologic stages in 1154 pts undergoing complete resection over a 9-yr period were analyzed.
Pts were assigned a stage based on both IASLC and UICC-6 systems.
Statistically meaningful differences were tested for between the 2 staging systems using the Wilcoxon signed rank test and the permutation test.

Results

The IASLC system is more effective than the UICC-6 system at ordering and differentiating pts.
Application of the IASLC system resulted in 202 (17.5%) pts being reassigned to a different stage, with the most common shifts occurring from IB to IIA and IIIB to IIIA.
5-yr and median survivals of the IASLC IIIA pts including those shifted from the UICC-6 IIIB were 37% and 35 mos, respectively.
Reclassifying UICC-6 IIIB to IASLC IIIA did not reduce survival for the newly characterized IIIA cohort.

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