Abstract 1166P
Background
Surgical resection is the primary treatment of choice for early stage (T1-3, N 0-1) Non-Small Cell Lung Cancer (NSCLC). We aimed to determine the degree of stage concordance between clinical (preoperative) and pathological (postoperative) stage following lung cancer resection, to examine factors likely to be causative of this discordance and to explore the impacts of stage discordance on survival.
Methods
We retrospectively identified patients with early stage NSCLC who underwent surgical resection between 2011 and 2020 at a large tertiary institution in Melbourne, Australia. Data on patient demographics, clinical and pathologic staging were obtained. Clinical staging was carried out using a CT, PET and various forms of nodal evaluation. Kappa index was used to determine the correlation between clinical and pathologic staging. Multivariable analysis was performed to evaluate the impact of those characteristics on the correlation rate.
Results
290 patients identified with interim analysis on 221 patients reported here. Majority were male 51.7% and 85.5% were smokers. 23.4% had squamous, 70.8% had adenocarcinoma histology and 60% had R sided cancers. The overall correlation rate between clinical and pathologic staging for T stage was 61.9% and 76.6% for N stage. Stage concordance was 58.5% and discordance was 40.5% with 53% up-staged and 43% down-staged at pathological diagnosis. The correlation rate was 61.9% for T1, 51.6% for T2, 50% for T3, and 84% for T4. This compared with 90.7% for N0, 26.8% for N1, and 55.5% for N2. In multivariable analysis, Age (p = 0.05) and smoking status (p=0.03) appear to influence rates of T stage correlation.
Conclusions
Our findings suggest that current clinical staging modalities have significant discrepancies in predicting pathologic stage for non-small cell lung cancer. Further optimization of clinical staging is essential for the accurate selection of patients who may benefit from guideline concordant treatment and may potentially help select patients who will benefit from neoadjuvant treatment modalities. Pathological upstaging may also potentially result in futile surgeries and adverse survival outcomes.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.