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This Article Full Text (PDF) Free All Versions of this Article: chest.06-1950v1 132/1/170    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tsuchiya, T. Articles by Nagayasu, T. Search for Related Content PubMed PubMed Citation Articles by Tsuchiya, T. Articles by Nagayasu, T.

Upstaging by Vessel Invasion Improves the Pathological Staging System of Non-Small Cell Lung Cancer

^aDepartments of Chest Surgery and ^dPathology, Oita Prefectural Hospital, 476 Bunyou Oita-city, Oita 870-8511, Japan ^bDivision of Surgical Oncology, Department of Translational Medical Sciences ^cDepartment of Radiation Epidemiology, Atomic Bomb Disease Institute, and Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, JAPAN ^eDepartment of Pathology, Nagasaki University Hospital, Nagasaki City, JAPAN

tomoshi{at}nagasaki-u.ac.jp

Abstract

BackgroundThere is a need for a more complete classification system of lung cancer. To address this issue, we assessed whether the new staging could differentiate patients with early stage cancers who have poorer prognosis and improve the unbalanced patient numbers with overlapping prognoses arising from the current tumor-node metastasis staging system.

MethodsThe study included 995 patients with pathological stages I and II NSCLC, who underwent surgical resection at two institutions. We subdivided patients with stage IA and IB NSCLC based on presence of vessel invasion (Vi). Stages IA Vi and IB non-Vi were combined into new stage IB, as were stages IB Vi and IIA into new stage IIA.

ResultsThe numbers of patients of stages IA, IB, IIA, IIB were 477, 314, 55, and 149, and their 5-year survival rates were 86.0%, 66.2%, 60.7%, and 50.4%, respectively. Vi groups showed significantly poorer prognosis than non-Vi groups at stage IA (P=0.011) and at stage IB (P=0.036). The numbers of patients of new stages IA, IB, and IIA were 333, 260, and 253, and their 5-year survival rates were 88.7%, 76.4%, and 61.2%, respectively. Regression analysis indicated that the new staging improved predictability of overall survival according to disease stage, and Akaike's information criterion (3023.7) was significantly lower than that for current staging system (3032.5).

ConclusionUpstaging of Vi groups allows differentiation of patients with early-stage cancers with poor prognosis and improves the unbalanced numbers of patients and prediction of prognosis in cases of lung cancer.

Key Words: lung cancer • staging • vessel invasion