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J Thorac Cardiovasc Surg 2002;123:409-410
© 2002 The American Association for Thoracic Surgery

Editorials

Molecular biologic substaging of non-small cell lung cancer

From the Department of Surgery, Duke University Medical Center, Durham, NC.

Received for publication July 25, 2001; accepted for publication Sept 13, 2001. Address for reprints: Thomas A. D'Amico, MD, Department of Surgery, Duke University Medical Center, Box 3496, Durham, NC 27710.

	Introduction

 
See related article on page 466.

The staging system for non-small cell lung cancer (NSCLC) provides a framework for the assessment of prognosis and the assignment of therapy for all patients with a new diagnosis of lung cancer, estimated to be 169,500 in the United States in 2001. ¹ The most recent revision of the lung cancer staging system, which considers the size and location of the primary tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastases (M), is based on the analysis of a collected database representing all clinical, surgical-pathologic, and follow-up information for 5319 patients treated for primary lung cancer. ² Similar results have been reported for a population of 6670 patients treated in Japan. ³

The power of these large databases in predicting prognosis is self-evident. Nevertheless, the inherent inaccuracy of the staging process should be brought to attention. According to the TNM system, the predicted 5-year survival after complete resection for T1 N0 M0 NSCLC (stage IA) is only 67%. ¹ Therefore 33% of patients with putative stage IA NSCLC have incorrectly staged disease and will die of it, predominantly from the development of metastatic disease not detected at the time of diagnosis and initial therapy.

Molecular biologic staging is the assessment of tumor markers associated . . . [Full Text of this Article]

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