Dissecting the heterogeneity of stage III non-small-cell lung cancer through incorporation of grade and histology.

Abstract

This study evaluated a grade-integrated American Joint Committee on Cancer (AJCC) staging system for non-small-cell lung cancer. Surveillance, Epidemiology and End Results database was queried through SEER*Stat program. Through recursive partitioning analysis and subsequent decision-tree formation, suggested grade-modified stages were formulated. All pairwise hazard ratio comparisons among AJCC eighth stages were significant (p<0.05) except stage IIIB versus stage IIIC; while all pairwise hazard ratio comparisons among modified AJCC stages were significant (p<0.05). When stratified by histology, there was a benefit for the modified system among adenocarcinoma rather than squamous cell carcinoma patients. Grade integration improved the prognostication of the AJCC staging system particularly for stage III adenocarcinoma. This should be considered in future revisions of the AJCC staging system.