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.

[Varicella pneumonia in the previously healthy adult]

Varicella (chickenpox) is a contagious, self-limited, usually benign disease common in childhood but uncommon in adulthood. Pneumonia is the most frequent complication of the disease in adults. We retrospectively review 7 cases of varicella pneumonia in previously healthy adults diagnosed in our hospital between 1992 and 1996. All of them were treated with intravenous acyclovir with good therapeutic response save for a patient who developed respiratory insufficiency and died 8 days after his admission. Smoking was the only risk factor detected. Clinical features of our patients are described and the need of an early diagnosis and treatment of varicella pneumonia is emphasized.

[Hepatic hydrothorax without ascites: presentation of a case and review of the literature]

Hepatic Hydrothorax is a well known complication in patients with cirrhosis and secondary ascites. It is unusual in the absence of ascites, with few cases reported in the literature. We describe a patient with Hepatic Hydrothorax without ascites and review the literature.

[Small cell lung carcinoma in the form of multiple lung nodules]

Small cell carcinoma of the lung occasionally presents as a single pulmonary nodule, but its expression in the form of multiple pulmonary nodules has not been reported in the literature. We describe a single case of small cell carcinoma of the lung presenting as multiple pulmonary nodules that seems to have been cured by chemotherapy.