To evaluate the prognostic impact on lung cancer patients with advanced stage of disease of new IASLC Revised Staging System in radically resection with adjuvant therapy.
From May 2004 to August 2008, 51 patients underwent surgery for advanced stage lung cancer. All the subjects were completely staged preoperatively also by PET/CT scan. Neo-adjuvant chemotherapy (CDDP-based 3 cycles) were given to 4 T2N2 tumor patients.We performed surgery procedure according to cStage: 25 bi- or simple lobectomies (7 associated thoracectomies), 5 wedge resections (2 associated thoracectomies), 2 pneumonectomies, 6 VATS pleurectomies, 3 VATS talc poudrages, 5 pericardial windows, 4 VATS mediastinal dissections, 1 thoracectomy.Histological examination showed 23 adenocarcinomas (3 associated BAC), 15 squamous carcinomas, 5 adenosquamous carcinomas, 1 mucoepidermal carcinoma, 1 carcinosarcoma and 6 no-defined carcinomas (all T4). Twelve tumors were classified T3N0, 3 T1N2, 5 T2N2, 2 T3N1, 9 T3N2, 7 T4N0 and 13 T4N2.We considered the previous CF Mountain 1997 Staging System and the new IASLC 2009 revision. According 1997 Staging System there were 12 IIb, 19 IIIa and 20 IIIb; according the new IASLC revision there were 12 IIb, 26 IIIa and 13 IIIb.Adjuvant chemotherapy (CDDP-based 4 cycles) were given to all patients but 10.Only 7 patients received adjuvant sequential mediastinal radiation.
According to the 2 different classifications (1997 versus 2009) the actuarial 3-years overall survivals predicted with Kaplan-Meier method were similar: 24%; there was no difference also for the Stage IIb: 26%. According to the 1997 CF Mountain Staging the Stage IIIa actuarial 3-years overall survival was 34% and 11% for the Stage IIIb. According to the new IASLC 2009 revision the Stage IIIa actuarial 3-years overall survival was 49% and 0% for the Stage IIIb.
To reinforce the new Staging System we reported a different survival rate according to the different T4N0 location in Stage IIIb.
The new IASLC Revised Staging System gives more suggestions to define better management in lung cancer patients.
Cosimo Lequaglie, No Financial Disclosure Information; No Product/Research Disclosure Information