Effect of histologically verified TNM stage on disease control in treated small cell carcinoma of the lung.

Pretreatment classification of patients with small cell carcinoma of the lung into categories of "limited" and "extensive" disease is inadequate; it does not identify the few having a good prognosis for disease control. Available reports from the literature were analyzed for (1) histologically verified TNM stage; (2) adequate treatment by current standards; and (3) number and percent of patients remaining in complete remission at 30 months after the start of treatment. Long-surviving patients by histologically verified stage were as follows: Stage I, 5 of 6 patients (83%); Stage II, 3 of 4 (75%); T3 without N2 or M1, 2 of 4 (50%); and N2 with any T value but without M1, 1 of 16 (6.2%). Long survivors with most distant involvement in the supraclavicular nodes were the following: ipsilateral, 3 of 22 (13.6%); contralateral, 2 of 40 (5%). Histologically verified M1 elsewhere allowed less than 1% long survivors. Indirect evidence of M1 by abnormal bone scan allowed less than 5%. Contrary to general usage, TNM staging of patients with small cell carcinoma of the lung promises to correlate closely with the probability of long disease-free survival.