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S.A. Deppen

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    P1.02 - Poster Session/ Treatment of Localized Disease – NSCLC (ID 209)

    • Event: WCLC 2015
    • Type: Poster
    • Track: Treatment of Localized Disease - NSCLC
    • Presentations: 1
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      P1.02-003 - Accuracy of Clinical and Pathologic Staging of Non-Small Cell Lung Cancer in a Residency Education Program (ID 2924)

      09:30 - 17:00  |  Author(s): S.A. Deppen

      • Abstract
      • Slides

      Accurate non-small cell lung cancer (NSCLC) clinical staging (CS) guides treatment options and prognosis. In addition, clinical and quality improvement registries incorporate CS and pathological staging (PS) for patients undergoing pulmonary resection. In residency education programs, CS and PS for NSCLC patients are essential educational components of thoracic surgical care. To determine the accuracy of CS by our house staff, we prospectively collected CS of patients who were treated by lobectomy (traditionally entered by our house staff) and compared those results to CS and PS in our cancer registry for accuracy and concordance.

      We conducted a retrospective analysis of prospectively collected clinical data between January 2005 and December 2014. Only patients with NSCLC who underwent anatomic pulmonary resection were included. We compared accuracy and Kappa score of preoperative CS entered by our house staff with the CS and PS obtained by our institutional cancer registry.

      A total of 915 patients underwent pulmonary resection operation for known or suspected lung cancer. 582 patients underwent lobectomy, segmentectomy, or sleeve resection for non-small cell lung cancer. The mean age at time of surgery was 65 years (95%CI: 64, 66), and 316 (56%) were women. Histology included adenocarcinoma, 292 (50%); squamous, 181, (31%); carcinoid, 40, (7%); large cell, 36, (6%); and others, NOS 30 (5%). CS by house staff compared to registry CS had 49% agreement and (expected agreement at random was 27% given 7 possible staging choices; Kappa score of interrater reliability of the 7 possible staging levels was 0.31). Agreement was significantly better than random (p<0.001) but Kappa score was relatively low. CS by house staff was compared to final PS had 52% agreement of an expected 28% and a Kappa score of 0.34. Final pathological stage by the author [MJA] or pathologist compared to cancer registry final pathology had 87% agreement and Kappa 0.83. House staff clinical nodal staging accuracy compared to pathological nodal staging had a higher absolute agreement (73%) than tumor staging (67%); however, due to fewer levels of nodal disease, higher agreement was expected in nodal staging. Adjusted level of agreement measured by Kappa score was lower in nodal staging, (0.14) compared to moderate agreement in tumor staging, Kappa 0.48. Registry CS absolute agreement for lymph nodes (66%) and tumor (63%) compared to PS was slightly lower than that of house staff (73% nodal and 67% tumor staging). This was largely due to the greater number of unstaged cancers (n=105) found in the registry.

      The cancer registry generally under stages the patient's CS compared to the PS. In addition, CS by trainees was only accurate in 52% of patients. The clinical nodal status had the lowest agreement (42%) after adjusting for the number of choices available by both our house staff and the cancer registry. Additional attention in trainee education, especially in the area of clinical nodal staging is necessary for improving CS and subsequent clinical decision making for our patients with NSCLC.

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