El fenómeno “Will-Rogers”. Migración de estadios en carcinoma broncogénico, tras aplicar criterios de certeza clasificatoria

López Encuentra, A.; Gómez de la Cámara, A.; Varela de Ugarte, A.; Mañes, N.; Llobregat, N.

doi:10.1016/S0300-2896(02)75183-1

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Abstract

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Objetivo

Cuantificar el cambio en la clasificación TNM-estadios (migración numérica) y la modificación en supervivencia (migración pronóstica) al aplicar criterios de certeza clasificatoria a una población de carcinoma broncogénico no microcítico (CBNM) con tratamiento quirúrgico

Métodos

La población está formada por 1.844 casos de CBNM operados entre 1993 y 1996 por los hospitales del Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y de Cirugía Torácica (GCCB-S)

La estadificación TNM quirúrgico-patológica (p) de cada paciente tiene dos clasificaciones; una inicial efectuada por cada centro del GCCB-S (TNMp-i) y otra, con mayor certeza clasificatoria (TNMp-cc), que se obtiene tras la aplicación de criterios más exigentes. En los casos en que ambas clasificaciones no coincidan se produce una migración numérica, evaluando la posible migración pronóstica con las nuevas estadificaciones

Resultados

Se detecta una gran migración numérica en la clasificación N0p (de 1.091 a 665 casos). Estos cambios no producen migraciones pronósticas en el grupo considerado globalmente, ni tampoco en las categorías T1–2N0M0p; sin embargo, en la clasificación T3N0M0p se incrementa en 13 meses la mediana de supervivencia. La diferencia de supervivencia a3años (S3) entre T3N0M0pi sin confirmación de certeza (S3=0,30; intervalo de confianza [IC] del 95%; 0,18–0,42; n=59) y T3N0M0p-cc (S3=0,54; IC del 95%=0,44–0,64; n=92) era significativa (rangos logarítmicos; p=0,035); este comportamiento no se observa en T1–2N0M0p

Conclusión

La migración numérica observada por la aplicación de criterios de certeza clasificatoria quirurgico-patológica es relevante, aunque la repercusión pronóstica es pequeña, salvo en T3N0M0p, en donde se detecta una mejora significativa del pronóstico (migración tipo fenómeno “Will-Rogers”)

Palabras clave:

Cáncer de pulmón

Pronóstico

Clasificación TNM

Estadificación

Migración de estadios

Objective

To quantify changes in tumornode-metastasis (TNM) staging (numerical migration) and survival (prognostic migration) that arise when certainty criteria are applied to a patient population with non-small cell lung cancer (NSCLC) treated surgically

Methods

The population consisted of 1,844 patients with NSCLC who underwent surgery between 1993 and 1996 at hospitals participating in the Bronchogenic Carcinoma Co-operative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). For every patient, surgical-pathological TNM staging (p) was based on two classifications: initial staging by each participating GCCB-S center (pTNM-i) and a second classification bearing greater classificatory certainty (pTNM-cc) resulting from the application of stricter criteria. Numerical migration was said to have occurred in cases where the two classifications did not coincide, and the possible prognostic migration under the new staging was then assessed

Results

The results revealed great numerical migration in the pN0 classification (from 1,091 cases to 665). The changes did not result in prognostic migration either for the group as a whole or for pT1–2N0M0 cases. However, for pT3N0M0 cases, median survival increased by 13 months. The difference in three-year survival (S3) for pT3N0M0-i without certainty confirmation [S3=0.30 (95%CI 0.18–0.42), n=59] and pT3N0M0-cc [S3=0.54 (95%CI=0.440.64), n=92] was significant (log-rank, p=0.035). Such behavior was not observed for pT1–2N0M0

Conclusions

The numerical migration observed as a result of applying surgical-pathological classificatory certainty criteria is relevant but the prognostic repercussion is scarce, except in cases classified as pT3N0M0, in which a significant positive prognostic migration is observed (the “Will Rogers phenomenon”)

Keywords:

Neoplasm

lung

staging

Prognosis

TNM classification

Stage migration

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Bibliografía

[1.]

International Union Against Cancer (UICC). TNM Classification of malignant tumours, 5th ed,

[2.]

T. Naruke, R. Tsuchiya, H. Kondo, H. Asamura, H. Nakayama.

Implications of staging in lung cancer.

Chest, 112 (1997), pp. 242-248s

[3.]

J.C. Nesbitt, J.B. Putnam, G.L. Walsh, J.A. Roth, C.F. Mountain.

Survival in early-stage non-small cell lung cancer.

Ann Thorac Surg, 60 (1995), pp. 466-472

Medline

[4.]

L.P. Fielding, C.M. Fenoglio-praiser, L.S. Freedman.

The future of prognostic factors in outcome prediction for patients with cancer.

Cancer, 70 (1992), pp. 2367-2377

Medline

[5.]

J.R. Jett.

What's new in staging of lung cancer?.

Chest, 111 (1997), pp. 1486-1487

Medline

[6.]

H. Kreisman, A. Lisbona, L. Olson, K.J. Propert, C. Modeas, R.O. Dillman, et al.

Effect of radiologic stage III substage on nonsurgical therapy of non-small cell lung cancer.

Cancer, 72 (1993), pp. 1588-1596

Medline

[7.]

A.R. Feinstein, D.M. Sosin, C.K. Wells.

The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer.

N Eng J Med, 312 (1985), pp. 1604-1608

[8.]

International Union Against Cancer (UICC). TNM supplement 1993. A commentary on uniform use,

[9.]

D.G. Pfister, C.K. Wells, C.h.K. Chan, A.R. Feinstein.

Classifying clinical severity to help solve problems of stage migration in nonconcurrent comparisons of lung cancer therapy.

Cancer Res, 50 (1990), pp. 4664-4669

Medline

[10.]

Grupo Cooperativo de Carcinoma Broncogénico de SEPAR (GCCB-S).

Cirugía del carcinoma broncogénico en España. Estudio descriptivo.

Arch Bronconeumol, 31 (1995), pp. 303-309

Medline

[11.]

A. López Encuentra.

and the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S): Criteria of functional and oncological operability in surgery for lung cancer A multicenter study.

Lung Cancer, 20 (1998), pp. 161-168

Medline

[12.]

D.L. Sackett, W.S. Richardson, W. Rosenberg, R.B. Haynes.

Evidencebased medicine, pp. 85-90

[13.]

Grupo Cooperativo de Carcinoma Broncogénico de SEPAR (GCCB-S): Control de calidad en un registro multiinstitucional de carcinoma broncogénico.

Arch Bronconeumol, 32 (1996), pp. s70

[14.]

H. Wada, F. Tanaka, K. Yanagihara, T. Ariyasu, T. Fukuse, H. Yokomise, et al.

Time trends and survival after operations for primary lung cancer from 1976 through 1990.

J Thorac Cardiovasc Surg, 112 (1996), pp. 349-355

http://dx.doi.org/10.1016/S0022-5223(96)70261-1 | Medline

[15.]

AJCC Cancer staging manual, 5th ed,

[16.]

American Thoracic Society/European Respiratory Society.

Pretreatment evaluation of non-small-cell lung cancer.

Am J Respir Crit Care Med, 156 (1997), pp. 320-332

http://dx.doi.org/10.1164/ajrccm.156.1.ats156.1 | Medline

[17.]

American Thoracic Society.

Clinical staging primary lung cancer.

Am Rev Respir Dis, 127 (1983), pp. 659-664

http://dx.doi.org/10.1164/arrd.1983.127.5.659 | Medline

[18.]

E.T. Lee.

Statistical methods for survival data analysis, pp. 67-101

[19.]

V. Abraira, A. Pérez de Vargas.

Métodos multivariantes en bioestadística. Análisis de supervivencia, pp. 283-333

[20.]

A.M. Bunt, J. Hermans, V.T. Smit, C.J. Van de Velde, G.J. Fleuren, J.A. Bruijn.

Surgical/pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries.

J Clin Oncol, 13 (1995), pp. 19-25

http://dx.doi.org/10.1200/jco.1995.13.1.19 | Medline

[21.]

F.D. Gilliland, W.C. Hunt, C.R. Key.

Improving survival for patients with prostate cancer diagnosed in the prostate-specific antigen ERA.

Urology, 48 (1996), pp. 67-71

Medline

[22.]

G.J. Bosl, N.L. Geller, E.Y. Chan.

Stage migration and the increasing proportion of complete responders in patients with advanced germ cell tumors.

Cancer Res, 48 (1988), pp. 3524-3527

Medline

[23.]

P.A. Thomas.

The role of mediastinal staging of lung cancer.

Chest, 106 (1994), pp. 331-333s

Medline

[24.]

E.C. Holmes.

General principles of surgery quality control.

Chest, 106 (1994), pp. S334-S336

[25.]

R.E. Dales, R.M. Stark, R. Sankaranarayanan.

Computed tomography to stage lung cancer.

Am Rev Respir Dis, 141 (1990), pp. 1096-1101

http://dx.doi.org/10.1164/ajrccm/141.5_Pt_1.1096 | Medline

[26.]

A. López Encuentra, A. Gómez de la Cámara.

for the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). The validation of a central review board of staging prior to surgery for non-small-cell lung cancer; impact of prognosis. A multicenter study.

Respiration, 69 (2002), pp. 16-24

http://dx.doi.org/49365 | Medline

[27.]

Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y Cirugía Torácica (GCCB-S).

Estadificación ganglionar intraoperatoria en la cirugía del carcinoma broncogénico. Documento de consenso.

Arch Bronconeumol, 37 (2001), pp. 495-503

Medline

[28.]

C.F. Mountain.

Revisions in the international system for staging lung cancer.

Chest, 111 (1997), pp. 1710-1717

Medline

[29.]

J.R. Izbicki, B. Passlick, K. Pantel, U. Pichlmeier, S.B. Hosch, O. Karg, et al.

Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer. Results of a prospective randomized trial.

Ann Surg, 227 (1998), pp. 138-144

Medline

[30.]

A.R. Feinstein, C.K. Wells.

A clinical-severity staging system for patients with lung cancer.

Medicine (Baltimore), 69 (1990), pp. 1-33

[31.]

International Union Against Cancer (UICC). Prognostic factors in cancer,

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Al final del artículo se presenta un apéndice con los miembros de grupo coordinador, responsables locales y hospitales, y unidad de análisis.

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