The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data

NSCLC Meta-analysis Collaborative Group, Lesley Stewart

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BACKGROUND: Clinical staging of non-small cell lung cancer (NSCLC) helps determine the prognosis and treatment of patients; few data exist on the accuracy of clinical staging and the impact on treatment and survival of patients. We assessed whether participant or trial characteristics were associated with clinical staging accuracy as well as impact on survival.

METHODS: We used individual participant data from randomized controlled trials (RCTs), supplied for a meta-analysis of preoperative chemotherapy (± radiotherapy) vs surgery alone (± radiotherapy) in NSCLC. We assessed agreement between clinical TNM (cTNM) stage at randomization and pathologic TNM (pTNM) stage, for participants in the control group.

RESULTS: Results are based on 698 patients who received surgery alone (± radiotherapy) with data for cTNM and pTNM stage. Forty-six percent of cases were cTNM stage I, 23% were cTNM stage II, and 31% were cTNM stage IIIa. cTNM stage disagreed with pTNM stage in 48% of cases, with 34% clinically understaged and 14% clinically overstaged. Agreement was not associated with age (P = .12), sex (P = .62), histology (P = .82), staging method (P = .32), or year of randomization (P = .98). Poorer survival in understaged patients was explained by the underlying pTNM stage. Clinical staging failed to detect T4 disease in 10% of cases and misclassified nodal disease in 38%.

CONCLUSIONS: This study demonstrates suboptimal agreement between clinical and pathologic staging. Discrepancies between clinical and pathologic T and N staging could have led to different treatment decisions in 10% and 38% of cases, respectively. There is therefore a need for further research into improving staging accuracy for patients with stage I-IIIa NSCLC.

Original languageEnglish
Pages (from-to)502-509
Number of pages8
Issue number3
Publication statusE-pub ahead of print - 26 Oct 2018

Bibliographical note

© 2018 The Authors. Published by Elsevier Inc under license from the American College of Chest Physicians.


  • Aged
  • Antineoplastic Agents/therapeutic use
  • Carcinoma, Non-Small-Cell Lung/drug therapy
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Lung Neoplasms/drug therapy
  • Male
  • Middle Aged
  • Neoplasm Staging/methods
  • Patient Selection
  • Preoperative Care/methods
  • Prognosis
  • Reproducibility of Results
  • Surgical Procedures, Operative/methods

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