The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the Clinical and Pathologic Staging of Small Cell Lung Cancer in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer

INTRODUCTION

Small cell lung cancer (SCLC) is commonly classified as either limited or extensive, but the Union for International Cancer Control TNM Classification of Malignant Tumours seventh edition (2009) recommended tumor, node, and metastasis (TNM) staging based on analysis of the International Association for the Study of Lung Cancer (IASLC) database.

METHODS

Survival analyses were performed for clinically and pathologically staged patients presenting with SCLC from 1999 through 2010. Prognosis was compared in relation to the TNM seventh edition staging to serve as validation and analyzed in relation to proposed changes to the T descriptors found in the eighth edition.

RESULTS

There were 5002 patients: 4848 patients with clinical and 582 with pathological stages. Among these, 428 had both. Survival differences were confirmed for T and N categories and maintained in relation to proposed revisions to T descriptors for seventh edition TNM categories and proposed changes in the eighth edition. There were also survival differences, notably at 12 months, in patients with brain-only single-site metastasis (SSM) compared to SSM at other sites, and SSM without a pleural effusion showed a better prognosis than other patients in the M1b category.

CONCLUSION

We confirm the prognostic value of clinical and pathological TNM staging in patients with SCLC, and recommend continued usage for SCLC in relation to proposed changes to T, N, and M descriptors for NSCLC in the eighth edition. However, for M descriptors, it remains uncertain whether survival differences in patients with SSM in the brain simply reflect better treatment options rather than better survival based on anatomic extent of disease.

[Minimally invasive video thoracoscopic correction of pectus excavatum]

Pectus excavatum, the most common congenital deformity of the chest wall, has esthetic, psychological and social repercussions as well as a slight impact on pulmonary function. Treatment is surgical and is carried out for esthetic purposes in most cases. The most commonly applied surgical technique is based on the one originally described by Ravitch: sub-perichondrial, bilateral chondrectomy and sternal osteotomy. In 1997, however. Nuss described a minimally invasive approach to correction by means of a support bar. Our objective was to perform minimally invasive correction of pectus excavatum using a substernal extrapleural approach guided by video-assisted thoracoscopy. We treated three patients over 15 years of age without surgical complications. In all three cases, the minimally invasive technique corrected the pectus excavatum with excellent esthetic results. Both the path of insertion and duration were shorter with the described approach than with traditional surgery. Video images facilitated extrapleural insertion of the bar and minimized complications.