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Japanese Journal of Clinical Oncology Advance Access originally published online on December 1, 2006
Japanese Journal of Clinical Oncology 2007 37(1):9-15; doi:10.1093/jjco/hyl119
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© 2006 Foundation for Promotion of Cancer Research

Revisit of 1997 TNM Staging System—Survival Analysis of 1112 Lung Cancer Patients in Taiwan

Reury-Perng Perng1, Chih-Yi Chen3, Gee-Chen Chang6, Te-Chun Hsia4, Nan-Yung Hsu5, Ying-Huang Tsai7, Chun-Ming Tsai1, Chih-Hsin Yang8, Yuh-Min Chen1, Chong-Jen Yu9, Jen-Jyh Lee10, Han-Shui Hsu2, Chih-Teng Yu7, Eing-Long Kao11 and Chao-Hua Chiu1,

1 Chest Department
2 Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei
3 Cancer Center
4 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine
5 Division of Chest Surgery, Department of Surgery, China Medical University Hospital, Taichung
6 Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung
7 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei
8 Department of Oncology
9 Department of Internal Medicine, National Taiwan University Hospital, Taipei
10 Division of Chest Medicine, Department of Internal Medicine, Buddhist Tzu Chi General Hospital, Hualien
11 Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

For reprints and all correspondence: Chao-Hua Chiu, Chest Department, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei, 112, Taiwan. E-mail: jhchiou{at}vghtpe.gov.tw

Received June 13, 2006; accepted August 28, 2006

BACKGROUND: There is neither a nation-wide nor a large-scale, multi-institutional lung cancer database available for stage-by-stage survival analysis in Taiwan at present.

METHODS: Using the data element provided by the International Association for the Study of Lung Cancer, the Taiwan Lung Cancer Society initiated a project to include native lung cancer patients into a global database. A total of 1112 Taiwan lung cancer patients treated in 7 medical centers were enrolled.

RESULTS: In small cell lung cancer, patients with ipsilateral pleural effusion had a survival between those with locoregional disease alone and those with distant metastasis; however, the difference was not statistically significant (P = 0.204). In non-small cell lung cancer, tumor size had significant survival influence for patients as a whole (P < 0.001) but it did not support the further division of stage IA according to tumor size (P = 0.122). The survival was compatible in stage IIIB and IV patients and therefore, the survival impact of pleural effusion cannot be determined. In patients with pIIIA-N2 disease, those who had station 8 nodal metastasis had inferior survival (P = 0.020) and station 5 superior survival (P = 0.010). In patients with distant metastasis, bone, liver, or distant lymph node metastasis predicted an inferior survival (all P values < 0.05).

CONCLUSIONS: The present study provides for comparison in this area a stage-by-stage reference for the survival of lung cancer patients. Some factors other than current TNM descriptors need to be further investigated in constructing the next version of the staging system.

Key Words: TNM staging system • Taiwan • lung cancer • survival analysis


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