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. 2009 Aug;138(2):412-418.e1-2.
doi: 10.1016/j.jtcvs.2009.01.033. Epub 2009 May 28.

Application of the revised lung cancer staging system (IASLC Staging Project) to a cancer center population

Edmund S Kassis  1 , Ara A Vaporciyan, Stephen G Swisher, Arlene M Correa, B Nebiyou Bekele, Jeremy J Erasmus, Wayne L Hofstetter, Ritsuko Komaki, Reza J Mehran, Cesar A Moran, Katherine M Pisters, David C Rice, Garrett L Walsh, Jack A Roth
Affiliations

Application of the revised lung cancer staging system (IASLC Staging Project) to a cancer center population

Edmund S Kassis et al. J Thorac Cardiovasc Surg. 2009 Aug.

Abstract

Objective: The International Association for the Study of Lung Cancer (IASLC) proposed a revision to the Union Internationale Contre le Cancer (UICC-6) staging system for non-small cell lung cancer. The goal of our study was to compare these systems in patients undergoing surgery for non-small cell lung cancer to determine whether one system is superior in staging operable disease.

Methods: Pathologic stages in 1154 patients undergoing complete resection over a 9-year period were analyzed. Patients were assigned a stage based on both IASLC and UICC-6 systems. We tested for statistically meaningful differences between the two staging systems using the Wilcoxon signed rank test and the permutation test.

Results: The IASLC system is more effective than the UICC-6 system at ordering and differentiating patients (P = .009). Application of the IASLC system resulted in 202 (17.5%) patients being reassigned to a different stage (P = .012), with the most common shifts occurring from IB to IIA and IIIB to IIIA. The 5-year and median survivals of the IASLC IIIA patients including those shifted from the UICC-6 IIIB were 37% and 35 months, respectively. Reclassifying UICC-6 IIIB to IASLC IIIA did not reduce survival for the newly characterized IIIA cohort.

Conclusion: Our data confirm that the proposed IASLC staging system is more effective at differentiating stage than the UICC-6 system. Reclassifying patients from UICC-6 IIIB to IASLC IIIA will shift some patients from a stage previously considered unresectable to a stage frequently offered surgical resection. Further study and validation of the IASLC system are warranted.

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Figures

FIGURE 1
FIGURE 1
Kaplan–Meier survival by overall stage for UICC-6 (A) and IASLC (B). HR, Hazard ratio; CI, confidence interval; MS, median survival; NR, not reached. UICC, Union Internationale Contre le Cancer; IASLC, International Association for the Study of Lung Cancer.
FIGURE 2
FIGURE 2
Shifting of stage after application of IASLC system. IASLC, International Association for the Study of Lung Cancer.
APPENDIX FIGURE 1
APPENDIX FIGURE 1
Distribution of differences under the null distribution.
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