Staging criteria for lung cancer face update

Current standards for a particular lung cancer scenario call for an "inoperable" classification. Researchers from the International Early Lung Cancer Action Program have presented evidence that suggests these criteria need to be changed.

Lung cancer screening participants who have more than one non-small cell lung cancer (NSCLC) at stage IIIB or IV and no associated metastases should be given the choice of resection, according to Dr. Claudia Henschke and colleagues at Cornell University.

Researchers found that people with this profile had a lower fatality rate than those with solitary pulmonary nodules.

In the ongoing International Early Lung Cancer Action Program (I-ELCAP), Henschke and colleagues found that 15% of the screening-diagnosed cases have more than one lung cancer but no evidence of metastases to lymph nodes or sites outside of the lungs.

The current staging criteria require that these cases be classified as inoperable stage IIIB or IV. The I-ELCAP sought to determine whether this classification was appropriate for asymptomatic, latent lung cancers diagnosed as a result of screening.

Researchers identified all resected NSCLC without evidence of metastases diagnosed on the initial CT in baseline or repeat screening. Kaplan-Meier analysis was used to determine the eight-year case-fatality rate for subjects with solitary and multiple lung cancers.

Of the 291 cancers with this profile, 256 (88%) were solitary and 35 (12%) were multiple. The size distribution was similar for the solitary cancers and for the dominant cancer in the multiple cases. Median diameter was 11 mm and 13 mm, respectively.

The eight-year fatality rate for solitary cases was 2.7% and 0% for multiple malignancies. Although the difference wasn't statistically significant, resection of the multiple nodules is beneficial, Henschke said.

"We suggest that these cases be classified as T and M status indeterminate or stage I* with further long-term follow-up," she said.

In Japan, radiologists already classify these cancers as stage I, offering patients the option of resection, according to Henschke. She offers that choice in her own clinical practice.

"The choice of resection should be given to each patient," she said.