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A. Mani



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    MA10 - Facing the Real World: New Staging System and Response Evaluation in Immunotherapy (ID 393)

    • Event: WCLC 2016
    • Type: Mini Oral Session
    • Track: Radiology/Staging/Screening
    • Presentations: 1
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      MA10.02 - Clinical Staging in the 8th Edition TNM for Lung Cancer is Inaccurate (ID 6362)

      14:26 - 14:32  |  Author(s): A. Mani

      • Abstract
      • Presentation
      • Slides

      Background:
      The new classification for lung cancer refines the T-descriptor criteria into more categories. We examined whether this affects the accuracy of clinical staging, and how this affects the final stage of patients.

      Methods:
      71 patients underwent resection for primary lung cancer from January 2014 to December 2014. T-component was measured based on the maximum tumour size on CT, PET-CT and histology report. The possible effect on staging based on T-component was compared between both TNMs.

      Results:
      PET-CT more accurately estimates the pathological size of the tumor (mean difference from histology: CT 3mm (range -1.6 to 2.6cm) and PET-CT 1.3mm (-2 to 2.5cm). Discordance between radiological and pathological T-stage was higher with the 8th edition (7th edition concordance CT 42(59%) and PET-CT 31(43%), 8th edition CT 31(44%) and PET-CT 29(41%) (CT p=0.01; PET-CT p=0.7)). The final stage groupings was also more discrepant in the 8th edition. Concordance was for CT 7th Edition 37(54%) vs 8th Edition 21(31%) (p<0.001), and for PET-CT 34(48%) vs 19(28%) (p<0.001). The discrepancy in stage grouping is contributed significantly by T-stage discordance. In the 30 patients who were not upstaged pathologically by pleural invasion or nodal staging, there is a over 50% increase in inaccuracy of clinical staging in the 8th edition. The CT concordance was 7th edition 24(80%), 8th edition 13(43%) (p<0.001); and for PET-CT 23(77%) vs 10(33%) (p<0.001).

      Conclusion:
      We showed that the 8th edition TNM lung cancer staging system was associated with a significant increase in discordance between clinical and pathological staging due to differences in measurement of tumour size and consequently T-stage groupings by different modalities. This has implications for prognostication and clinical trial interpretation especially in patients who do not undergo surgery for pathological stage confirmation.Figure 1



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