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

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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 ; Stewart, Lesley.

In: Chest, Vol. 155, No. 3, 26.10.2018, p. 502-509.

Research output: Contribution to journalArticlepeer-review

Harvard

NSCLC Meta-analysis Collaborative Group & Stewart, L 2018, 'The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data', Chest, vol. 155, no. 3, pp. 502-509. https://doi.org/10.1016/j.chest.2018.10.020

APA

NSCLC Meta-analysis Collaborative Group, & Stewart, L. (2018). The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data. Chest, 155(3), 502-509. https://doi.org/10.1016/j.chest.2018.10.020

Vancouver

NSCLC Meta-analysis Collaborative Group, Stewart L. The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data. Chest. 2018 Oct 26;155(3):502-509. https://doi.org/10.1016/j.chest.2018.10.020

Author

NSCLC Meta-analysis Collaborative Group ; Stewart, Lesley. / The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer : An Analysis Based on Individual Participant Data. In: Chest. 2018 ; Vol. 155, No. 3. pp. 502-509.

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@article{36431413cc5c4750a026df2999e39435,
title = "The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data",
abstract = "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.",
keywords = "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",
author = "{NSCLC Meta-analysis Collaborative Group} and Neal Navani and Fisher, {David J} and Tierney, {Jayne F} and Stephens, {Richard J} and Sarah Burdett and Lesley Stewart",
note = "{\textcopyright} 2018 The Authors. Published by Elsevier Inc under license from the American College of Chest Physicians.",
year = "2018",
month = oct,
day = "26",
doi = "10.1016/j.chest.2018.10.020",
language = "English",
volume = "155",
pages = "502--509",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "3",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer

T2 - An Analysis Based on Individual Participant Data

AU - NSCLC Meta-analysis Collaborative Group

AU - Navani, Neal

AU - Fisher, David J

AU - Tierney, Jayne F

AU - Stephens, Richard J

AU - Burdett, Sarah

AU - Stewart, Lesley

N1 - © 2018 The Authors. Published by Elsevier Inc under license from the American College of Chest Physicians.

PY - 2018/10/26

Y1 - 2018/10/26

N2 - 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.

AB - 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.

KW - Aged

KW - Antineoplastic Agents/therapeutic use

KW - Carcinoma, Non-Small-Cell Lung/drug therapy

KW - Female

KW - Humans

KW - Kaplan-Meier Estimate

KW - Lung Neoplasms/drug therapy

KW - Male

KW - Middle Aged

KW - Neoplasm Staging/methods

KW - Patient Selection

KW - Preoperative Care/methods

KW - Prognosis

KW - Reproducibility of Results

KW - Surgical Procedures, Operative/methods

U2 - 10.1016/j.chest.2018.10.020

DO - 10.1016/j.chest.2018.10.020

M3 - Article

C2 - 30391190

VL - 155

SP - 502

EP - 509

JO - Chest

JF - Chest

SN - 0012-3692

IS - 3

ER -