Anatomy, Biology and Concepts, Pertaining to Lung Cancer Stage Classification

AbstractThe proposed lung cancer stage classification system remains grounded in anatomic characteristics, although the large patient database contributing to this revision has dramatically expanded our body of knowledge. Predictably this has led to increased complexity due to the identification of an increasing number of subpopulations of patients. Patterns of clinical presentation characterizing these subgroups may provide clues about the propensity of tumors within a subgroup toward a particular pattern of biologic behavior. This article explores concepts regarding tumor biology that can be applied to the anatomically based new staging system

Thoroughness of Mediastinal Staging in Stage IIIA Non-small Cell Lung Cancer

IntroductionGuidelines recommend that patients with clinical stage IIIA non-small cell lung cancer (NSCLC) undergo histologic confirmation of pathologic lymph nodes. Studies have suggested that invasive mediastinal staging is underutilized, although practice patterns have not been rigorously evaluated.MethodsWe used the Surveillance, Epidemiology, and End Results-Medicare database to identify patients with stage IIIA NSCLC diagnosed from 1998 through 2005. Invasive staging and use of positron emission tomography (PET) scanning were assessed using Medicare claims. Multivariable logistic regression was used to identify patient characteristics associated with use of invasive staging.ResultsOf 7583 stage IIIA NSCLC patients, 1678 (22%) underwent invasive staging. Patients who received curative intent cancer treatment were more likely to undergo invasive staging than patients who did not receive cancer-specific therapy (30% versus 9.8%, adjusted odds ratio, 3.31; 95% confidence interval, 2.78–3.95). The oldest patients (age, 85–94 years) were less likely to receive invasive staging than the youngest (age, 67–69 years; 27.6% versus 11.9%; odds ratio, 0.46; 95% confidence interval, 0.34–0.61). Sex, marital status, income, and race were not associated with the use of the invasive staging. The use of invasive staging was stable throughout the study period, despite an increase in the use of PET scanning from less than 10% of patients before 2000 to almost 70% in 2005.ConclusionNearly 80% of Medicare beneficiaries with stage IIIA NSCLC do not receive guideline adherent mediastinal staging; this failure cannot be entirely explained by patient factors or a reliance on PET imaging. Incentives to encourage use of invasive staging may improve care

Year Book of Pulmonary Disease 2016

The Year Book of Pulmonary Disease brings you abstracts of the articles that reported the year's breakthrough developments in pulmonary disease carefully selected from more than 500 journals worldwide. Expert commentaries evaluate the clinical importance of each article and discuss its application to your practice. Topics such as Asthma and Cystic Fibrosis, Chronic Obstructive Pulmonary Disease, Lung Cancer, Community-Acquired Pneumonia, Lung Transplantation, Sleep Disorders, and Critical Care Medicine are represented highlighting the most current and relevant articles in the field

The IASLC Lung Cancer Staging Project: Background Data and Proposed Criteria to Distinguish Separate Primary Lung Cancers from Metastatic Foci in Patients with Two Lung Tumors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer

It can be difficult to distinguish between a second primary and a metastasis in patients with lung cancer who have more than one pulmonary site of cancer.status: publishe

The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic-Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification

Application of tumor, node and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type of involvement. Clarification of how to do this is needed for the forthcoming 8(th) edition of TNM classification.status: publishe