89P - Investigating the potential utility of the alternative IASLC nodal staging classification in NSCLC

Date 15 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Poster lunch
Topics Non-Small-Cell Lung Cancer, Early Stage
Imaging, Diagnosis and Staging
Presenter Timothy Edwards
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors T. Edwards1, H. Al-Najjar1, P. Crosbie1, J. Martin1, A. Chaturvedi2, M. Evison1, R. Booton1
  • 1North West Lung Centre, Wythenshawe Hospital-South Manchester University Hospitals Trust, M23 9LT - Manchester/GB
  • 2Department Of Histopathology, Wythenshawe Hospital-South Manchester University Hospitals Trust, M23 9LT - Manchester/GB

Abstract

Background

The International Association for the Study of Lung Cancer (IASLC) lung cancer staging project has recently published recommendations for the forthcoming 8th edition of the TNM classification of lung cancer. This recommends the same N descriptors be used, however, further analysis of an alternative system was recommended. The aim of this study was to assess the utility of this proposed new nodal staging system from surgical data at a large United Kingdom tertiary lung cancer centre.

Methods

Patients who underwent surgical resection for non-small cell lung cancer between 2011 and 2012 (to allow minimum 3 years follow-up) were identified from a prospective database (n = 499). Analysis of pathological staging as per the proposed nodal staging was performed. The proposed staging divides N1 into N1 at single station (N1a) and N1 at multiple stations (N1b), N2 into N2 at single station without N1 involvement (N2a1), N2 at a single station with N1 involvement (N2a2) and N2 at multiple stations (N2b). Survival data was obtained from national death registries.

Results

There was no statistically significant difference in survival between pN1a and pN1b (HR = 1.33 (0.58, 3.03); p = 0.50] or pN2a and pN2b [HR = 0.93 (0.47, 1.84); p = 0.83]. 89PT1 Table: Survival by nodal staging

StageSurvival
 1-year2-year3-year
pN0 (n = 323)87%78%71%
pN1a (n = 62)84%70%65%
pN1b (n = 19)79%58%58%
pN2a1 (n = 13)62%54%54%
pN2a2 (n = 33)76%52%35%
pN2b (n = 21)81%52%47%

Conclusions

There appears to be no additional staging value by further sub-dividing the N1 and N2 groups. However, the study is severely limited by the small numbers of patients within these sub-divisions. Additional survival data will become available prior to presentation that may add to further weight to these results. The validity of this data is also highly dependent on the adequacy of intra-operative lymph node sampling which we have reported to have been sub-optimal in this time period. Prospective data is collected for all NSCLC resections at our institution and this data will mature in time, particularly in a more recent period of significant improvement in the adequacy of lymph node sampling and increase in the volume of resections.

Legal entity responsible for the study

University Hospitals of South Manchester

Funding

Manchester Thoracic Oncology Centre

Disclosure

All authors have declared no conflicts of interest.