91P - Validation of the 7th and upcoming 8th TNM staging system in small cell lung cancer

Date 15 April 2016
Event European Lung Cancer Conference 2016 (ELCC) 2016
Session Poster lunch
Topics Small-Cell Lung Cancer
Staging procedures (clinical staging)
Basic Principles in the Management and Treatment (of cancer)
Imaging
Presenter Salomon Tendler
Citation Journal of Thoracic Oncology (2016) 11 (supplement 4): S57-S166. S1556-0864(16)X0004-4
Authors S. Tendler, R. Lewensohn, K. Viktorsson, L. de Petris
  • Oncology-pathology, Karolinska University Hospital-Solna, 17176 - Stockholm/SE

Abstract

Background

The purpose of this study was to evaluate whether the 7th and upcoming 8th TNM staging system can provide additional prognostic information in comparison with the previous 6th TNM version and the older 2-stage LD vs ED system, on a Swedish cohort of small cell lung cancer (SCLC).

Methods

We retrospectively reviewed the medical records of patients (pts) with proven histology/cytology SCLC diagnosed between Jan 2008 and Jan 2013 in the Stockholm region. A baseline CT thorax/upper abdomen was a requirement for inclusion. Patients with stage IA-IIB (n = 7 pts), combined-type histology were excluded. Each patient file was revised and reclassified from the VASGL system to the 6th, 7th and 8th TNM system respectively. We assessed overall survival (OS) according to the T, N, M-descriptor and compared LD/ED with the 6th, -7th, -8th editions of TNM. Four separate multivariate models (adjusted for basic patient characteristics i.e. age, gender, WHO performance status and baseline levels of Hb, CRP and Na) were therefore performed.

Results

In total, 249 pts were eligible for the study. Median age was 69 years and 136 pts (55%) were females. Median OS was 6.2 months. The results of re-staging patients according to the different classification systems are presented in Table 1, where HR and 95% CI for multivariate analyses are given. There were no cases of M1b classified according to the 8th TNM.

Conclusions

The results from this ongoing study indicate that the 8th TNM classification system is a more accurate predictor of prognosis in patients with locally-advanced/ metastatic SCLC patients as compared to previous TNM versions and the old VALSG classification. Nonetheless, the majority of patients (>70%) were stage IV at diagnosis with multiple metastatic localizations. For this large group a more detailed prognostic classification based on the extension of tumor burden is warranted. Additional data on a larger cohort will be presented at the conference. 91PT1 Table 1.

 VALSG6th TNM7th TNM8th TNM
 # (%)HR (95% CI)# (%)HR (95% CI)# (%)HR (95% CI)# (%)HR (95% CI)
P-value 0.0012 0.06 0.002 0.0004
LD36 (14)1      
 ED213 (86)1.44 (1.14–1.87)      
 IIIA  12 (5)0.59 (0.29–1.04)14 (5)0.55 (0.30–0.90)10 (4)0.40 (0.17–0.78)
 IIIB  34 (14)1.14 (0.76–1.76)37 (15)1.09 (0.75–1.60)28 (11)1.06 (0.66–1.65)
 IIIC      13 (5)1.32 (0.72–2.2)
 IV  203 (81)1198 (80)1  
 IVA      22 (9)0.99 (0.61–1.54)
 IVB      176 (71)1

Clinical trial identification

Legal entity responsible for the study

Karolinska Institute

Funding

Karolinska Institute

Disclosure

All authors have declared no conflicts of interest.