Original article
General thoracic
Comparison Between Clinical and Pathologic Staging in 2,994 Cases of Lung Cancer

https://doi.org/10.1016/j.athoracsur.2004.06.004Get rights and content

Background

The accuracy of clinical staging in lung cancer may be evaluated by comparing it against the gold standard of pathologic staging. The objective of this paper is to compare these two staging methods in a series of 2,994 lung cancer cases operated on consecutively in Spain between 1993 and 1997.

Methods

The raw frequency of agreement was used to compare clinical against pathologic staging and to assess the agreement. Kappa's index was used to determine the random effect of agreement.

Results

Ninety-three percent of the entire population were men, with a mean age of 64 years (median, 66; SD, 9.6). The majority of cases were classified as squamous tumors (1,774; 59%), with complete resection (2,410; 80%), and with lobectomy or bilobectomy (1,490; 55%). The most frequently found pathologic stage was pIB (997; 37%), followed by pIIIA (524; 19%). Considering the 2,377 cases with clinical and pathologic staging data, a classification coincidence was observed in 1,108 cases (47%; Kappa's index 0.248 for stages IA through IIIB). Considering the pathologic staging as the gold standard, the agreement was 75% for stages IA-IB (Kappa's index 0.56). In general, downstaging is more frequent than upstaging.

Conclusions

This recent series of lung cancer showed the low diagnostic accuracy of the clinical staging as compared with the pathologic staging. Diagnostic accuracy was found to be much higher in the initial IA-IB stages, as illustrated by Kappa's index.

Section snippets

Patients

All the patients included in the study had lung cancer in initial stages and had undergone thoracotomy with intent to cure in hospitals pertaining to the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery [11].

We included prospectively all patients treated surgically from October 1993 to September 1997 in hospitals participating in the GCCB-S. The annual cumulative number of cases was close to 50% of surgical cases occurring in Spain. The

Descriptive Study

The majority of patients were male (2,771; 93%), mean age was 64 years (SD, 9.6; median, 66; minimum, 30; maximum, 91; 25th percentile, 59; 50th percentile, 66; 75th percentile, 71). Eighty-seven percent of cases were smokers or ex-smokers; in 2,585 patients it was possible to determine the level of smoking, with a mean of 57.5 package-year (SD, 30; median, 50). Of the 2,994 patients, 57% admitted being an active smoker.

Table 1 shows the rest of the characteristics for these cases. The

Comment

The main objective of this study on a recent series of 2,994 lung cancer cases compiled by the GCCB-S is to analyze the accuracy of the clinical staging by comparing it against the best gold standard, pathologic staging. Of the three staging components, this comparison is only valid for T and for N, given that thoracotomy, the gold standard for this staging, can hardly modify the M clinical classification. This study shows that both staging methods coincide in fewer than half of cases, with a

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