For more than 50 years, small cell lung cancer (SCLC) has been staged mainly as either
limited or extensive stage disease. Small published series of resected SCLC have suggested
that the tumor, node, metastases (TNM) pathologic staging correlates with the survival
of resected patients. Recent analysis of the 8088 cases of SCLC in the International
Association for the Study of Lung Cancer (IASLC) database demonstrated the usefulness
of clinical TNM staging in this malignancy. The IASLC data bank contains an unprecedented
number of resected SCLC cases with pathologic staging information. This analysis was
undertaken to examine the impact of the TNM system on the pathologic staging of SCLC
and to assess the new IASLC proposals in this subtype of lung cancer.
Using the IASLC database, survival analyses were performed for resected patients with
SCLC. Prognostic groups were compared, and the new IASLC TNM proposals were applied
to this population and to the Surveillance, Epidemiology, and End Results (SEER) database.
The IASLC database contained 349 cases of resected SCLC where pathologic TNM staging
was available. Survival after resection correlated with both T and N category with
nodal status having a stronger influence on survival. Stage groupings using the 6th
edition of TNM clearly identify patient subgroups with different prognoses. The IASLC
proposals for the 7th edition of TNM classification also apply to this population
and to the SEER database.
This analysis further strengthens our previous recommendation to use TNM staging for
all SCLC cases.