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Dorothy Jane Giroux
WS04 - Staging Workshop Part 1: IASLC Database Challenges and Application (ID 105)
- Event: WCLC 2019
- Type: Workshop
- Track: Staging
- Presentations: 1
- Now Available
- Moderators:Paula Antonia Ugalde, Maria Teresa Tsukazan
- Coordinates: 9/09/2019, 14:00 - 15:30, San Francisco (2009)
WS04.05 - Developing the IASLC Lung Cancer Staging Database and Recommendations for the 9th Edition (Now Available) (ID 3682)
14:00 - 15:30 | Presenting Author(s): Dorothy Jane Giroux
Developing the IASLC lung cancer staging database and recommendations for the 9th edition
Since the turn of the century, the international database of the IASLC Staging Project has served as the foundation for evidence-based recommendations for revisions to the TNM classification system for lung cancer. These recommendations were adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), establishing the IASLC Staging Project as a global resource for lung cancer staging research. The project is currently midway through its third iteration of data collection, which was begun in 2017 and includes lung cancer cases diagnosed from 2011 through 2019, with follow-up for survival through 2021. The preferred mechanism for data collection is direct, online entry into a central database administered by Cancer Research and Biostatistics (CRAB) in Seattle, Washington.
The data fields in the lung cancer database are extensive, having been revised in 20171 by the IASLC Staging and Prognostic Factors Committee (SPFC) to address specific research questions framed by each of its 15 subcommittees, such as the impact of direct extension into specific anatomic sites on survival, the relative effects of location vs size of involved nodes, or the importance of the size of distant metastases relative to the number of lesions and distant sites. The committee will consider the prognostic value of these anatomic parameters independently and in the context of non-anatomic factors such as sex, comorbidity, laboratory values that correlate with survival, or molecular markers. Existing institutional databases and large registries have traditionally been used to supplement the data contributed using the online system; however, these external sources rarely contain sufficient detail to address all of the committee’s stated objectives.2
The SPFC is chaired by Hisao Asamura, MD, and has separate subcommittees for T, N, M, ground glass opacities and adenocarcinoma in situ, neuroendocrine tumors, stage groupings, lymph node chart, validation and methodology, prognostic factors, R factor (completeness of resection), radiology and imaging, multiple pulmonary nodules, molecular markers, and data quality, as well as a steering committee that provides oversight. SPFC members are expected to demonstrate leadership and promote participation in the project, as well as develop and evaluate proposals for change. The current SPFC membership reflects the diverse geographic representation in the database used to support the most recent (8th edition) recommendations.
As of 5 June 2019, over 3,000 patients from 14 countries have been enrolled directly in the online system. Larger databases designed to be compatible with the project have also been transferred from Japan and the United States.
In the newly redesigned IASLC web site (www.iaslc.org), new participants can sign up online to contribute data by choosing the IASLC Staging Project page under the Research & Education heading. Following the publication of the core recommendations for the 9th edition of TNM, the web site may also be used to submit research proposals for secondary use of the data. Secondary use may be restricted according to agreements with individual sites in some cases. All proposals will be reviewed by the steering committee according to published guidelines.3
In the context of shifting paradigms and rapid advancements in treatments, diagnostics, and molecular technologies, the SPFC is tasked with evaluating and improving TNM staging on a global scale. To this end, we aim to engage a wide variety of research partners and to increase participation in previously underrepresented regions such as Egypt and India, where the first sites from each of these countries have recently been recruited. The collection of a large and comprehensive database will be pivotal to the SPFC’s ability to provide data-informed, universally applicable, and balanced recommendations that will be used world-wide by physicians, researchers, and patients. As we continue to prepare for upcoming analysis of the 9th edition database, the IASLC membership is encouraged to participate through the contribution of data and engagement with the SPFC and its mission. This global effort to improve the TNM staging criteria presents a unique opportunity to collaborate in international public health research.
Giroux DJ, Schil PV, Asamura H, et al. The IASLC Lung Cancer Staging Project: A Renewed Call to Participation. J Thorac Oncol 2018;13:801-809.
Rami-Porta R, Bolejack V, Giroux D, et al. The IASLC Lung Cancer Staging Project: The New Database to Inform the Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2014;9:1618-1624.
Goldstraw P, Rami-Porta, R, and Crowley J. We Probably Have the Answer: Now What is the Question? J Thorac Oncol 2009;4:939-940.
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