Poor correspondence between clinical and pathologic staging in stage 1 non-small cell lung cancer: results from CALGB 9761, a prospective trial

被引:82
作者
D'Cunha, J
Herndon, JE
Herzan, DL
Patterson, GA
Kohman, LJ
Harpole, DH
Kernstine, KH
Kern, JA
Green, MR
Maddaus, MA
Kratzke, RA
机构
[1] Univ Minnesota, Sch Med, Div Cardiovasc & Thorac Surg, Minneapolis, MN 55455 USA
[2] Ctr Stat, Canc & Leukemia Grp B S, Durham, NC USA
[3] Univ Minnesota, Sch Med, Sect Hematol Oncol Transplant, Minneapolis, MN 55455 USA
[4] Washington Univ, Sch Med, Div Cardiothorac Surg, Sect Gen Thorac Surg, St Louis, MO 63110 USA
[5] SUNY Upstate Med Univ, Thorac Div, Syracuse, NY USA
[6] Duke Univ, Med Ctr, Durham, NC USA
[7] Univ Iowa, Iowa City, IA USA
[8] Case Western Reserve Univ, Univ Hosp Cleveland, Cleveland, OH 44106 USA
[9] Med Univ S Carolina, Div Med Oncol, Charleston, SC 29425 USA
[10] Minneapolis Vet Affairs Med Ctr, Res Serv, Minneapolis, MN USA
关键词
D O I
10.1016/j.lungcan.2004.11.006
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: A major problem with the staging system for non-small cell Lung cancer (NSCLC) is clinical underestimation of the extent of disease. Many patients with clinical stage 1 disease do not retain that designation following surgical resection. Herein, we present data from Cancer and Leukemia Group B (CALGB) protocol 9761 evaluating the correspondence between clinical and pathologic analysis in early stage NSCLC. Methods: Five hundred and two patients with suspected or biopsy-proven NSCLC classified as clinical stage 1 (T1-2, N0) by computed tomography (CT) scan or cervical mediastinoscopy were prospectively enrolled in CALGB 9761. The purpose of CALGB 9761 was to prospectively evaluate molecular markers of micrometastatic disease in stage 1 NSCLC. Enrollment occurred at 11 selected institutions within the CALGB. Patients with clinically suspected resectable early stage lung cancer were eligible for enrollment if they had no evidence of mediastinal or hilar adenopathy on CT scan or if they had CT evidence of potential N2 or N3 disease (lymph node >= 1.0 cm) but with negative mediastinoscopy. No prior chemotherapy or radiotherapy was permitted. Results: Of the 502 patients felt to have clinical stage 1 NSCLC enrolled in CALGB 9761, 489 underwent resection with complete surgical staging and routine histopathologic analysis. From these 489 patients, only 422 (86.3%) turned out to have pathologically documented NSCLC. Of these 422 patients, 302 (71.6%) had pathologic stage 1 disease (173 stage 1A and 129 stage 1B). Despite clinical assessment of stage 1 disease, 59 (14%) patients had pathologic stage 2 disease, 57 (13.5%) had stage 3 disease, and four (0.9%) patients had stage 4 disease. Of the patients undergoing resection for clinical stage 1 NSCLC, 65 patients did not have NSCLC (44 had benign disease and 21 had malignancies other than NSCLC) and two additional patients had dual synchronous primary NSCLC tumors and were not eligible for the study. Overall, only 61.7% (302 of 489) of patients with suspected stage 1 NSCLC disease retained that stage and diagnosis after complete surgical staging, white 38.3% had an inaccurate pre-operative clinical stage or diagnosis. Conclusions: The results from this prospective trial demonstrate the poor predictive value of current clinical staging techniques in early stage NSCLC. These findings will serve as a benchmark for comparison of future clinical imaging modalities and other tests evaluating early stage NSCLC. (c) 2004 Elsevier Ireland Ltd. All rights reserved.
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收藏
页码:241 / 246
页数:6
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