Results of surgical treatment of non–small cell lung cancer: validation of the new postoperative pathologic tnm classification

Abstract

Objective: Prognostic relevance of the current TNM stage grouping for lung cancer is still a matter of debate. Methods: To validate the new pathologic TNM classification for non–small cell lung cancer, we analyzed the survival data of 586 patients who underwent complete pulmonary resection and pathologic staging at one institution. Results: The current TNM stage grouping well reflected the long-term prognostic hierarchy. There was a good distinction between new substages IA and IB (5-year survivals of 66% and 53%, respectively). The subdivision of stage II led to an under-representation of stage IIA (6 patients [1.0%]), and therefore the appropriateness of this modification could not be verified. Five-year survival in the T3 N0 category (30%) was significantly better than that found in the new stage IIIA (15%). No difference was found between T3 N0 and T2 N1, the categories constituting new stage IIB. Within stage IIIA there was a significant survival difference between T3 N2 (6%) and the remaining T and N designations (18%). Moreover, the 5-year survival in the T3 N1 category (35%) was similar to that found in the new stage IIB (27%) and better than in any T N2 tumors (12%). Conclusion: Most of our findings confirmed prognostic relevance of the current pTNM stage grouping in patients with resectable non–small cell lung cancer. However, despite recent modifications, there is still a significant heterogeneity that flaws stage IIIA. (J Thorac Cardiovasc Surg 2000;119:1141-6)