The relevance of the revised version of the international lung cancer staging system for non-small-cell lung cancer treated with radiotherapy.

In 1997, the International Union Against Cancer (UICC) introduced a new version of staging for lung cancer. The purpose of this study was to determine the prognostic value of the new UICC staging (1997) among patients with inoperable non-small-cell lung cancer (NSCLC) treated with radiotherapy. The status of a total of 1354 inoperable patients postintrathoracic irradiation for NSCLC was retrospectively analyzed. Restaging was performed according to the staging system of the UICC 1997. The median survival (MS) among patients with stage I disease was 12.4 months. In the case of stage IA disease, the MS was 17.6 months, which was significantly better compared to the 11.2 months observed among patients with stage IB disease (P = 0.002). The MS among patients with clinical T2 N1 M0 disease (stage IIB) was 8.0 months. The MS among those with clinical T3 N0 M0 disease (stage IIB) was 8.6 months, which was not statistically different from the group of patients with stage IIIA disease, who had an MS of 7.6 months. The MS among patients with stage IIIB disease was 6.5 months, and among patients with stage IV disease, MS was 4.0 months. It was concluded that in patients with inoperable NSCLC treated with radiotherapy, the distinction between stages IA and IB disease in the new staging system is clinically relevant. There was no significant difference in survival between patients with stage IIB and IIIA disease. The results clearly show that the prognostic significance of a staging system mainly based on surgically treated patients should be analyzed separately before it can be used among patients treated with nonsurgical modalities.