Concordance between clinical and pathology TNM-staging in lung cancer

Steinar Solberg; Yngvar Nilssen; Odd Terje Brustugun; Per Magnus Haram; Åslaug Helland; Bjørn Møller; Trond-Eirik Strand; Sissel Gyrid Freim Wahl; Lars Fjellbirkeland

doi:10.1016/j.lungcan.2022.07.014

Concordance between clinical and pathology TNM-staging in lung cancer

Lung Cancer. 2022 Sep:171:65-69. doi: 10.1016/j.lungcan.2022.07.014. Epub 2022 Jul 25.

Authors

Steinar Solberg¹, Yngvar Nilssen², Odd Terje Brustugun³, Per Magnus Haram⁴, Åslaug Helland⁵, Bjørn Møller², Trond-Eirik Strand⁶, Sissel Gyrid Freim Wahl⁷, Lars Fjellbirkeland⁸

Affiliations

¹ Department of Registration, Cancer Registry of Norway, Oslo, Norway; Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway. Electronic address: stsg@kreftregisteret.no.
² Department of Registration, Cancer Registry of Norway, Oslo, Norway.
³ Section of Oncology, Viken Hospital Trust, Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁴ Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Oncology, Oslo University Hospital, Oslo, Norway.
⁶ Department of Patient Safety and Quality, Oslo University Hospital, Oslo, Norway; Department of Community Medicine, UiT, The Arctic University of Norway, Tromsø, Norway.
⁷ Department of Pathology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁸ Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Respiratory Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway.

PMID: 35926242
DOI: 10.1016/j.lungcan.2022.07.014

Abstract

Objectives: A prerequisite for utilizing the tumour, lymph-nodes, and metastases (TNM) for the staging of lung cancer patients is a high quality of the reported data on which the staging is based. The aim of this study was to investigate the concordance between the clinical, cTNM and the pathology, pTNM staging for lung cancer, version 8 as reported to the Cancer Registry of Norway (CRN).

Materials and methods: A total of 1284 patients who underwent surgery 2018-2019 with sufficient data regarding both clinical and pathology T and N descriptors were included.

Results: The differences in tumour diameter reported in the clinical and the pathology notifications were ≤5 mm and ≤10 mm in 65.9 % and in 84.4 % of the cases, respectively. For the c- and pT categories, there was concordance in 53.4 % while 28.4 % were upstaged and 18.2 % were downstaged. For N categories there was concordance in 83.3 % while 13.7 % were upstaged and 3.0 % were downstaged. Unforeseen pN2 was found in 6.2 % of the cases. For TNM staging groups there was concordance in 48.1 % of the cases, while 33.4 % were upstaged and 18.5 % were downstaged. The calculated sensitivity and specificity for reported cTNM staging as diagnostic test for being eligible for adjuvant treatment (stage II-IIIA) were 0.65 and 0.91, respectively.

Conclusions: These data on staging for lung cancer, as reported to the CRN, shows a disappointingly low precision and concordance in c- and pTNM staging. This urges a strategy for a marked improvement.

Keywords: Lung cancer; Pathology; Staging; Surgery; TNM.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Humans
Lung Neoplasms* / pathology
Neoplasm Staging
Norway / epidemiology
Prognosis
Sensitivity and Specificity