Chest

Chest

Volume 115, Issue 6, June 1999, Pages 1507-1513
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Clinical Investigations
Lung Cancer
Impact of Revised Stage Classification of Lung Cancer on Survival: A Military Experience

https://doi.org/10.1378/chest.115.6.1507Get rights and content

Study objectives

This report reviews results of surgical management of lung cancer at a military medical center using the revised 1997 stage classification and determines the impact of the revised system on survival rates. It also compares our results with the recent reports from Japan and from a large, multinational study involving several institutions.

Design

Retrospective review.

Setting

Department of Cardiothoracic Surgery, Walter Reed Army Medical Center (WRAMC), Washington, DC.

Patients or participants

Active military members, their dependents, and eligible retired military members who were admitted to WRAMC for surgical treatment of lung cancer between January 1984 and December 1996.

Methods

Records of all patients who had surgical resection with intent to cure were reviewed. Data extracted included clinical and pathologic stages according to the 1997 revised stage classification. Survival probabilities for the stages were calculated by the Kaplan-Meier actuarial method. The log rank test was used to compare survival rates between stages and stage subsets. A p value < 0.05 was considered statistically significant.

Measurements and results

Five hundred fifty-two of the 1,398 patients with primary lung cancers underwent curative surgical resection (39.5%). The operative mortality was 2%. Using the revised 1997 stage classification, the survival rate for stage IA was 77%; IB, 62%; IIA, 57%; IIB, 47%; IIIA, 28%; IIIB, 20%; and IV, 0%. The overall actuarial 5-year and 10-year survival rates were 58% and 45%, respectively (median survival, 3.3 years; mean survival 3.9 ± 0.1 years).

Conclusions

Our results confirm the justification for the recent revisions in the staging system of lung cancer; however, there are still discrepancies that cannot be explained.

Section snippets

Materials and Methods

Between January 1984 and December 1996, 1,398 patients were registered in the Lung Cancer Tumor Registry at Walter Reed Army Medical Center (WRAMC). The medical records of the 552 patients who underwent surgical resection with intent to cure were analyzed. All patients were operated on by residents under the supervision of staff thoracic surgeons. Thoracic lymphadenectomy was not routinely performed during this period of review, but mediastinal nodal sampling was obtained from at least four

Description of Population

Of the 1,398 patients with primary lung cancer, 552 patients (39.5%) underwent surgical resection with intent to cure. There were 392 men (71%) and 160 women (29%), with ages ranging from 31 to 95 years old (median, 64 years old; mean (± SD), 63 ± 10 years old). Four hundred seventy-seven patients (86.4%) were white, 68 patients (12.3%) were African-American, and 7 patients (1.3%) were Asian. This is consonant with the ethnic composition of the US Army. Four hundred ninety-eight patients

Discussion

The past few years have brought significant changes to the classification and staging of lung cancer. These changes became necessary as a result of the heterogeneity of end results existing from the TNM categories within stage groups and of the need for greater specificity in stage classification. In 1996, the AJCC and UICC adopted several revisions to the 1986 stage classification, changes that were later published by Mountain in 1997 (Table 1).5 Also, Mountain and Dresler6 have addressed the

Conclusion

This study supports the recent changes in the staging system of lung cancer as reported by Mountain in 19975 and confirmed by Inoue and associates in 1998.7 Our survival rates are similar, particularly among patients with stages I to IIIA. It would appear that the survival rates for the various stages and substages are in flux, and there may be a need for future modifications as we gain more knowledge about the biological behavior of lung cancer. The recent proposal by Margolis18 for a simple

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For related article see page 1494.

The opinion and assertions contained herein are the private views ofthe authors and are not to be construed as official or as reflectingthe views of the Department of the Army, the Department of Veterans Affairs, or the Department of Defense.

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Copyright © 1999 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.