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

David Jonathan Heineman, Martijn Geert Ten Berge, Johannes Marlene Daniels, Michaël Ignatius Versteegh, Perla Jacqueline Marang-van de Mheen, Michael Wilhelmus Wouters, Wilhelmina Hendrika Schreurs

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)1615-1621
Number of pages7
JournalThe Annals of Thoracic Surgery
Volume102
Issue number5
DOIs
Publication statusPublished - Nov 2016

Cite this

Heineman, David Jonathan ; Ten Berge, Martijn Geert ; Daniels, Johannes Marlene ; Versteegh, Michaël Ignatius ; Marang-van de Mheen, Perla Jacqueline ; Wouters, Michael Wilhelmus ; Schreurs, Wilhelmina Hendrika. / 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. In: The Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 5. pp. 1615-1621.
@article{25fac533460843639e6475091fb19ce8,
title = "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",
abstract = "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.",
author = "Heineman, {David Jonathan} and {Ten Berge}, {Martijn Geert} and Daniels, {Johannes Marlene} and Versteegh, {Micha{\"e}l Ignatius} and {Marang-van de Mheen}, {Perla Jacqueline} and Wouters, {Michael Wilhelmus} and Schreurs, {Wilhelmina Hendrika}",
note = "Copyright {\circledC} 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.",
year = "2016",
month = "11",
doi = "10.1016/j.athoracsur.2016.07.054",
language = "English",
volume = "102",
pages = "1615--1621",
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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. / Heineman, David Jonathan; Ten Berge, Martijn Geert; Daniels, Johannes Marlene; Versteegh, Michaël Ignatius; Marang-van de Mheen, Perla Jacqueline; Wouters, Michael Wilhelmus; Schreurs, Wilhelmina Hendrika.

In: The Annals of Thoracic Surgery, Vol. 102, No. 5, 11.2016, p. 1615-1621.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Clinical Staging of Stage I Non-Small Cell Lung Cancer in the Netherlands-Need for Improvement in an Era With Expanding Nonsurgical Treatment Options

T2 - Data From the Dutch Lung Surgery Audit

AU - Heineman, David Jonathan

AU - Ten Berge, Martijn Geert

AU - Daniels, Johannes Marlene

AU - Versteegh, Michaël Ignatius

AU - Marang-van de Mheen, Perla Jacqueline

AU - Wouters, Michael Wilhelmus

AU - Schreurs, Wilhelmina Hendrika

N1 - Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

PY - 2016/11

Y1 - 2016/11

N2 - 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.

AB - 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.

U2 - 10.1016/j.athoracsur.2016.07.054

DO - 10.1016/j.athoracsur.2016.07.054

M3 - Article

VL - 102

SP - 1615

EP - 1621

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -