Author of

• 10974

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  P1.21 - Poster Session 1 - Diagnosis and Staging (ID 169)

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Prevention & Epidemiology
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 10977

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    P1.21-003 - Impact on stage migration in lung cancer from 6th to 7th edition of TNM a study conducted at two hospitals in Nepal. (ID 1448)

    09:30 - 09:30  |  Author(s): R. Pun
    • Abstract

    Background
    Lung cancer is the leading cause of cancer related morbidity and mortality in both the sexes in Nepal. It accounts for 15.4 % of total cancer as per hospital based Cancer Registry in Nepal. Patient usually present with stage III (55%) or IV (34%) disease. With the revision of Lung cancer staging system by International Association of the study of Lung Cancer (IASLC) and adoption of this Seventh edition of staging system by American Joint Comitte on Cancer (AJCC) in 2010, we tried to make an attempt and to recognize how many percentages of patients will upstage and downstage with comparison to the sixth edition of staging system.

    Methods
    This retrospective cross-sectional observational study was conducted at Department of Radiotherapy and Oncology, Bir Hospital and National Hospital and Cancer Research Centre, Nepal. We reviewed the record of the entire registered, histologically diagnosed lung cancer patient in these two centers during the year 2012. Total of 151 patient’s record were analyzed and restaged using both sixth and the seventh edition of staging system. The data were recorded and evaluated.

    Results
    Male preponderance observed with 63% of the cases and female of 37%. The mean age group was 63.93 years with the youngest being 31 years and the eldest with 83 years of age. The total patients in the different stage with seventh edition observed are IB 2(1%0, IIA 6(4%), IIB (8%), IIIA 59(39%), IIIB 24(16%), and IV 52 (34%. Stage migration was seen in 15.23 % of the total cases. Most prominent was downstage from IIIB to IIIA which accounts for the 7% of all the cases. This downstage is due to the Tumor size >7cm and a separate tumor nodule in the same lobe which elaborates T3 of the seventh edition. Next prominent stage migration noticed was due to categorization of pleural fluid cytology as M1a in seventh edition, which cause a total of 4% of cases to be upstaged from IIIB to IV, which in fact this may further increase. The entire patients presented with pleural effusion have not undergone cytological evaluation because in most of these cases T4 disease was due to invasion and or satellite nodule along with the pleural effusion so effusion was ignored as per 6[th] edition. Rest patient were downstage from T4 to T3 and T3 to T2, which is due to the sub categorization of the tumor by size.

    Conclusion
    In this cohort of patients, there was downstaging from IIIB to IIIA and upstaging from IIIB to IV because of revised TNM classification. Thus, we feel that a prospective larger study is required as it will further allow us to explain the prognosis and the survival pattern based on the staging system and we strongly recommend to have detailed staging and a routine pleural fluid cytology in the patient with pleural effusion before initiation of the treatment.