Document Detail

Lung cancer staging: a physiological update.
MedLine Citation:
PMID:  22419795     Owner:  NLM     Status:  MEDLINE    
The tumour-node metastasis (TNM) classification system is anatomically based. We investigated whether the addition of simple physiological variables, age and body mass index (BMI), would affect survival curves, i.e. a composite anatomical and physiological staging system. We retrospectively analysed a prospectively validated thoracic surgery database (n = 1981). Cox multivariate analysis was performed to determine possible significant factors. Kaplan-Meier survival curves were constructed with combined anatomical and physiological factors. Cox multivariate analysis revealed age (P < 0.001) and BMI (P = 0.01) as significant factors affecting survival. Receiver operating curve analysis determined cut-off levels for age of 67 and BMI of 27.6. A composite anatomical and physiological survival curve based on TNM for BMI > 27.6 and age < 67 was produced. Age and BMI criteria resulted in significantly different survival curves, for stage I (P < 0.0001) and stage II (P = 0.0032), but not for stage III (P = 0.06). Neural network analysis confirmed the importance of BMI and age above cancer stage with regard to long-term survival. Combining age < 67, BMI > 27.6 and TNM anatomical classification results in very different estimated survival curves from the usual TNM system. Patients from stages I, II and III may have survival equivalent to a stage higher or lower depending on their age and BMI.
Michael Poullis; James McShane; Mathew Shaw; Steven Woolley; Michael Shackcloth; Richard Page; Neeraj Mediratta
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Publication Detail:
Type:  Journal Article     Date:  2012-03-14
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  14     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-16     Completed Date:  2012-09-07     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  743-9     Citation Subset:  IM    
Liverpool Heart and Chest Hospital, Liverpool, UK.
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MeSH Terms
Age Factors
Body Mass Index
Kaplan-Meier Estimate
Lung Neoplasms / mortality,  pathology*,  physiopathology,  therapy
Lymph Nodes / pathology
Lymphatic Metastasis
Middle Aged
Multivariate Analysis
Neoplasm Staging / methods*
Neural Networks (Computer)
Positron-Emission Tomography
Predictive Value of Tests
Proportional Hazards Models
ROC Curve
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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