|
|
|
|
PROPOSAL
TO MODIFY THE ACTUALLY STAGING OF CANCER OF THE LUNG
M.
Costa Angeli, E. Tisi, D. Ballabio, C .Arrigoni, E. Cassina,
E. Corno, T. Di Sibio, C. Benenti. DIVISIONE DI CHIRURGIA TORACICA
OSPEDALE SAN GERARDO -
AZIENDA OSPEDALIERA - MONZA
We revised the results of surgical treatment in lung
cancer patients to verify whether pre-operative staging could effectively
predict homogeneous pattern of survival. Similar outcome should be observed in
patients assigned to the same staging group and receiving similar treatment. We
analysed data from a total of 773 patients referred to our department during a
period of 21 years (1972 through 1993). We split this population into two
subsets of patients corresponding to different preoperative staging techniques:
group A) (n=355) patients observed in the 1972 – 1980 period, when CT scan was
not still available; group B) (n=418) patients observed in the 1985 – 1993
period, when CT scan was available. We did not consider the 1972 – 1980 period
due to considerable interlope between conventional and CT radiology techniques. Overall
survival rates were comparable between group A and group B. Analysis of within
stage survival rates showed homogeneous distribution of survival within stages I
and II only. In stage IIIA, we observed higher survival rate in substages T3N0
and T3N1 (46%) than in substage N2 (2-4%). The
clinical importance of the N status is unquestionable. However, stage grouping
according to the current TNM classification does not adequately emphasise the
relative effect on outcome of the N status, compared to the T status.
We
propose a modified staging classification which groups in stage II patients
having no lymphonodal involvement (N0) but having neoplastic involvement of
adjacent structures (T3). We suggest that the current II stage and substage T3N1 should be grouped together in stage IIIA,
including therefore all patients with local lymphonodal involvement. N2 status
patients could be included in stage IIIB, representing the actual operability
limit. Patients from substages N3 and T4 should be all included in stage IIIC.
Patients
from stages IIIB and IIIC could benefit from surgical exeresis following
neoadjiuvant chemotherapy with or without radiation therapy. Stage IV would be
unmodified, compared to the current classification.
MODIFIED STAGING
|
|
|
Potete
inviare a