The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands: 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: 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.

Original languageEnglish
Pages (from-to)1622-1629
Number of pages8
JournalThe Annals of Thoracic Surgery
Volume102
Issue number5
DOIs
Publication statusPublished - Nov 2016

Cite this

Heineman, D. J., Ten Berge, M. G., Daniels, J. M., Versteegh, M. I., Marang-van de Mheen, P. J., Wouters, M. W., & Schreurs, W. H. (2016). The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands: Data From the Dutch Lung Surgery Audit. The Annals of Thoracic Surgery, 102(5), 1622-1629. https://doi.org/10.1016/j.athoracsur.2016.06.071
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. / The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands : Data From the Dutch Lung Surgery Audit. In: The Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 5. pp. 1622-1629.
@article{d248d2f131804430a572616eef767883,
title = "The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands: Data From the Dutch Lung Surgery Audit",
abstract = "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.",
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.",
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Heineman, DJ, Ten Berge, MG, Daniels, JM, Versteegh, MI, Marang-van de Mheen, PJ, Wouters, MW & Schreurs, WH 2016, 'The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands: Data From the Dutch Lung Surgery Audit' The Annals of Thoracic Surgery, vol. 102, no. 5, pp. 1622-1629. https://doi.org/10.1016/j.athoracsur.2016.06.071

The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands : 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. 1622-1629.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The Quality of Staging Non-Small Cell Lung Cancer in the Netherlands

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: 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.

AB - 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.

U2 - 10.1016/j.athoracsur.2016.06.071

DO - 10.1016/j.athoracsur.2016.06.071

M3 - Article

VL - 102

SP - 1622

EP - 1629

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -