Staging of small cell lung cancer (SCLC): Comparison of two criteria by survival analysis

Abstract

17030 Background: Consistent staging of SCLC is pertinent to the selection and evaluation of treatment regimens. The Veterans Administration Lung Study Group (VALG) defines patients with limited disease (LD) as those with tumor limited to one hemithorax. In contrast, the International Association for the Study of Lung Cancer (IASLC), basically a TNM method, defines limited disease as those with no distant metastases. We assessed the survival of intermediate patients (ID), defined as those who qualified as LD by the IASLC but not the VALG criteria. Methods: A retrospective chart review was done on 252 patients consecutively diagnosed with SCLC between 1990 and 2004 at a Northern California hospital. Kaplan Meier analysis and log-rank tests were used to compare the survival of ID and LD patients. We also compared survival of both ID and LD to patients with extensive disease (ED). Multivariate Cox regression analysis was used to incorporate clinically relevant data. Bonferroni adjustment was made for multiple comparisons. Results: We defined 93 patients as LD, 32 as ID and 127 as ED. Median survival of patients with ID was 12 months (95% CI 9–16 months) and for LD 11 months (95% CI 9–13 months). Median survival for patients with ED was 6 months (95% CI 4–7 months) and significantly shorter (P < .0001) than either ID or LD. Conclusions: The present study questions the inclusiveness of the VALG definition of LD concurs with prior findings from Germany (Lung Cancer 37:271, 2002). SCLC patients should be staged by the IASLC criteria when being evaluated for treatment regimens. No significant financial relationships to disclose.