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Non–Sized-Based Descriptors in Staging of Stage I Non-small Cell Lung Cancer FREE TO VIEW

Angel López-Encuentra, MD, PhD
Author and Funding Information

Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery Madrid, Spain

Correspondence to: Angel López-Encuentra, MD, PhD, Pneumology Service, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain; e-mail: lencuent@h12o.es


The author has no conflict of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(3):673-674. doi:10.1378/chest.08-0893
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To the Editor:

Ou et al1 have recently reported an excellent experience assessing non–sized-based descriptors in staging of stage I non-small cell lung cancer (NSCLC). We concur with their basic message that tumor size < 3 cm is the most important favorable prognostic factor among all descriptors for stage I NSCLC.

Nonetheless, some questions still remain. The work is based on clinically staged patients. No information is provided on whether all or part of these patients are staged pathologically, which would increase classificatory certainty. If these were clinical T1–2N0M0, certainty is more imprecise. How can it be clinically claimed that the visceral pleura is only involved in a tumoral process? Or how can it be clinically claimed that an NSCLC falls into a clinical N0 classification?

A further problem is the absence of cases with two or more stage I descriptors. In our experience2 in patients with pathologic stage I with a tumor > 3 cm in size (n = 804), there is simultaneous concurrence of 254 patients (32%) with involvement of the visceral pleura, 223 patients (28%) with atelectasis-pneumonitis, and 59 patients (7%) in whom the main bronchium is involved > 2 cm from the carina.

In the reference work,1 it is claimed that in tumors < 3 cm, some non–sized-based descriptors are indeed independent prognostic factors. Given that new proposals have come to light to handle the “tumor size” variable, with greater prognostic discrimination using cut-off values > 2 to 3 cm,2,3 the question is: In your largest study, would non–sized-based descriptors disappear as prognostic values if, on multivariate analysis, tumor size were to be considered in a larger number of cut-off values? Our experience suggests so.4

Ou SH, Zell JA, Ziogas A, et al. Prognostic significance of the non-size-based AJCC T2 descriptors: visceral pleura invasion, hilar atelectasis, or obstructive pneumonitis in stage IB non-small cell lung cancer is dependent on tumor size. Chest. 2008;133:662-669. [PubMed] [CrossRef]
 
López-Encuentra A, Duque-Medina JL, Rami-Porta R, et al. Is 3 cm a prognostic threshold in pathologic stage I non-small cell lung cancer? A multicenter study of 1,020 patients. Chest. 2002;121:1515-1520. [PubMed]
 
Rami-Porta R, Ball D, Crowley J, et al. Proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:593-602. [PubMed]
 
López-Encuentra A, Gómez de la Cámara A, Rami-Porta R, et al. Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S): previous tumour as a prognostic factor in stage I non-small cell lung cancer. Thorax. 2007;62:386-390. [PubMed]
 

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References

Ou SH, Zell JA, Ziogas A, et al. Prognostic significance of the non-size-based AJCC T2 descriptors: visceral pleura invasion, hilar atelectasis, or obstructive pneumonitis in stage IB non-small cell lung cancer is dependent on tumor size. Chest. 2008;133:662-669. [PubMed] [CrossRef]
 
López-Encuentra A, Duque-Medina JL, Rami-Porta R, et al. Is 3 cm a prognostic threshold in pathologic stage I non-small cell lung cancer? A multicenter study of 1,020 patients. Chest. 2002;121:1515-1520. [PubMed]
 
Rami-Porta R, Ball D, Crowley J, et al. Proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2007;2:593-602. [PubMed]
 
López-Encuentra A, Gómez de la Cámara A, Rami-Porta R, et al. Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S): previous tumour as a prognostic factor in stage I non-small cell lung cancer. Thorax. 2007;62:386-390. [PubMed]
 
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