New system bests conventional staging for NSCLC

  • Haro GJ & al.
  • JAMA Netw Open
  • 2 Dec 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • A staging system for patients with NSCLC that incorporates tumor size, nodal status, metastasis, and biology (TNMB) was associated with more accurate identification of patients at risk for recurrence than the widely used TNM system.

Why this matters

  • Studies of the eighth edition of the TNM staging system, adopted in 2018, have found it offers no improvement in survival estimation over the seventh edition.
  • In addition to the order and priority of conventional staging, the TNMB system uses molecular risk to up- or downstage patients.

Study design

  • 238 patients who underwent surgical resection for stage I-IIIC NSCLC were restaged with the seventh or eighth TNM editions and the TNMB system.
  • Median follow-up, 25 months.
  • Funding: None disclosed.

Key results

  • TNMB was associated with better identification of high-risk patients and better differentiation between patients with and without recurrence (net reclassification improvement, 0.28; P<.001>
  • No significant improvement between the seventh and eighth editions.
  • Nagelkerke R2, log-rank χ2, and area under the receiver operating characteristic curve (C-index) remained static between the seventh and eighth editions, but improved with TNMB system (χ2, 108; R2, 0.31; and C-index, 0.73), suggesting an improved overall model fit and better discrimination than with TNM.

Limitations

  • Single-center study.