The IASLC Lung Cancer Staging Project: External Validation of the Revision of the TNM Stage Groupings in the Eighth Edition of the TNM Classification of Lung Cancer

Kari Chansky, Frank C Detterbeck, Andrew G Nicholson, Valerie W Rusch, Eric Vallières, Patti Groome, Catherine Kennedy, Mark Krasnik, Michael Peake, Lynn Shemanski, Vanessa Bolejack, John J Crowley, Hisao Asamura, Ramón Rami-Porta, IASLC Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions, Erik Jakobsen (Member of author group)

Research output: Contribution to journalJournal article

Abstract

INTRODUCTION: Revisions to the TNM stage classifications for lung cancer, informed by the international database (N = 94,708) of the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee, need external validation. The objective was to externally validate the revisions by using the National Cancer Data Base (NCDB) of the American College of Surgeons.

METHODS: Cases presenting from 2000 through 2012 were drawn from the NCDB and reclassified according to the eighth edition stage classification. Clinically and pathologically staged subsets of NSCLC were analyzed separately. The T, N, and overall TNM classifications were evaluated according to clinical, pathologic, and "best" stage (N = 780,294). Multivariate analyses were carried out to adjust for various confounding factors. A combined analysis of the NSCLC cases from both databases was performed to explore differences in overall survival prognosis between the two databases.

RESULTS: The databases differed in terms of key factors related to data source. Survival was greater in the IASLC database for all stage categories. However, the eighth edition TNM stage classification system demonstrated consistent ability to discriminate TNM categories and stage groups for clinical and pathologic stage.

CONCLUSIONS: The IASLC revisions made for the eighth edition of lung cancer staging are validated by this analysis of the NCDB database by the ordering, statistical differences, and homogeneity within stage groups and by the consistency within analyses of specific cohorts.

Original languageEnglish
JournalJournal of Thoracic Oncology
Volume12
Issue number7
Pages (from-to)1109-1121
Number of pages13
ISSN1556-0864
DOIs
Publication statusPublished - Jul 2017

Keywords

  • AJCC
  • Lung cancer
  • National Cancer Database
  • Staging
  • UICC
  • Validation

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    Chansky, K., Detterbeck, F. C., Nicholson, A. G., Rusch, V. W., Vallières, E., Groome, P., Kennedy, C., Krasnik, M., Peake, M., Shemanski, L., Bolejack, V., Crowley, J. J., Asamura, H., Rami-Porta, R., IASLC Staging and Prognostic Factors Committee, Advisory Boards, and Participating Institutions, & Jakobsen, E. (2017). The IASLC Lung Cancer Staging Project: External Validation of the Revision of the TNM Stage Groupings in the Eighth Edition of the TNM Classification of Lung Cancer. Journal of Thoracic Oncology, 12(7), 1109-1121. https://doi.org/10.1016/j.jtho.2017.04.011