Evaluation of Eighth AJCC TNM Sage for Lung Cancer NSCLC: A Meta-analysis
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Evaluation of Eighth AJCC TNM Sage for Lung Cancer NSCLC: A Meta-analysis Durgesh Wankhede, MBBS, MS Department of Surgical Oncology, All India Institute of Medical Science, Ansari Nagar, New Delhi, India
ABSTRACT Introduction. The AJCC 8th edition TNM classification for lung cancer was released in 2017. This edition has made major changes in many tumor descriptors including sites of metastasis. The new staging system has been a subject of multiple validation studies, of which many have had mixed results. The present study is designed to critically evaluate the results of these external validation studies. Methods. A metaanalysis of these external validation studies was performed to critically evaluate the new staging system. Out of 12 studies, 8 were found to fulfill the eligibility criteria, with 654,185 patients being included in the analysis. Hazard ratios (HRs) and associated 95% confidence intervals (CI) extracted from these studies were utilized for analysis. The primary outcomes were survival discrimination and prognostic ability of the 8th edition compared with the 7th edition. Results. The HRs for the 8th edition staging system were 1.41 in IB, 1.64 in IIA, 1.24 in IIB, 1.95 in IIIA, 3.96 in IIIB, and 4.82 in IIIC compared with IA. The new edition fared better than the 7th edition in survival discrimination in all but stage IIA and IIB. The C-index of the 8th and 7th editions was 0.690 and 0.688, respectively, suggesting almost similar prognostic values.
Conclusions. This study shows that the survival discrimination of the 8th edition fared better than the 7th edition in all but stage IIA and IIB. The prognostic value of the two staging systems is similar, with no added advantage of the new edition.
Lung cancer is the second most common cause of cancer-related mortality and second to prostate and breast cancer in terms of incidence. Lung cancer mortality rates have declined in the past decade, but the 5-year survival still remains abysmal.1,2 Staging is one of the most important predictor of survival and is a crucial part of lung cancer management. The 7th edition of tumor–node– metastasis (TNM) staging was published in 2009 based on datasets not meant for stage classification. The 7th edition had some descriptors which were not validated.3 The 8th staging was unveiled in 2017 with main changes related to tumor size, extent of involvement, and subclassification of extrathoracic metastases (Table 1).4 Multiple external validation studies were conducted focusing on various descriptors of the new staging system and obtained mixed results.5–16 The present meta-analysis of studies is designed to evaluate the survival discrimination and prognostic value of the AJCC 8th edition TNM classification for lung cancer. METHODS
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09151-9) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 20 July 2020 Ac
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