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- et al.
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Patients and Methods
Process of Development of Proposals
Structure of the SPFC
General Approach and Guiding Principles
- Groome P.A.
- Bolejack V.
- Crowley J.
- et al.
|Descriptors should be applicable to both clinical and pathologic stage classification|
|Changes in T, N, and M categories should not compromise the use of data from the previous staging system whenever possible|
|Criteria for clinical T, N, and M categories should match those for pathologic T, N, and M categories|
|If boundaries between categories are to be changed, there should be overwhelming evidence to support such changes|
|Unproven descriptors should be “flagged” for further testing|
|Pathologic stage classification should include consideration of incompletely resected cases (R1, R2)|
|Prediction of prognosis associated with tumor stage should be supplemented by other prognostically important factors in a validated system (e.g., histologic diagnosis, age, sex, performance status, comorbidities)|
|Evidence from external sources should be taken into consideration.|
|Transportability (applicability)||Historical||Is discrimination maintained in populations from a different era than the one used to develop the system?|
|Geographic||Is discrimination maintained in populations from a different geographic region than the ones used to develop the system?|
|Methodologic||Is discrimination maintained in cohorts identified in different ways (e.g., CT vs. PET, c-stage vs. p-stage)?|
|Spectrum||Is discrimination maintained in populations with a different spectrum of disease (e.g., different histotypes, smokers vs. nonsmokers, symptom detected vs. screen detected)?|
|Follow-up interval||Is appropriate ordering of groups maintained across the follow-up spectrum (e.g., at 1, 2, 3, 5, and 10 years)?|
|Implementability||Simplicity||Is it simple, intuitive, easy, and practical to implement?|
|Clarity||Is it defined in unambiguous terms?|
Characteristics of the Database
|Pathologic Stage||n||Clinical Stage||n|
|N0 M0 R0||21,133||N0 M0||10,230|
|N-any M0 R0||27,986||N-any M0||12,956|
|N0 M0 R-any||22,257|
|T-any M0 R0||29,728||T-any M0||38,910|
|T1 M0 R0||12,824||T1 M0||15,681|
|T2 M0 R0||12,785||T2 M0||13,476|
|T3 M0 R0||3636||T3 M0||5004|
|T4 M0 R0||483||T4 M0||4729|
|T-any M0 R-any||31,426|
|M component (nonsurgically managed)|
|—||—||T-any N-any M1a||324|
|—||—||T-any N-any M1b||735|
|T-any N-any M0||31,936||T-any N-any M0||16595|
|T-any N-any M1||0||T-any N-any M1||882|
Evaluation of the T Component
Evaluation of the N Component
Evaluation of the M Component
Evaluation of Stage Grouping
- Zell J.A.
- Ou S.H.I.
- Ziogas A.
- Anton-Culver H.
Criteria to Assess Stage Classification
- Austin P.
- Steyereberg E.
Requirements for Robust External Validation
- Austin P.
- Steyereberg E.
|Independent cases||Cases not already included in IASLC database|
|Sample size||No. cases and events (total and per analyzed subgroup)|
|Follow-up||Median f/u (till death or last known status); no. lost to f/u|
|Ordering||What is the order of subgroups examined?|
|Discrimination||Degree of statistical difference between cohorts|
|Consistency||Were findings consistent in different cohorts (e.g., c-stage, p-stage, N0, N-any, R0, R-any cohorts)?|
|Homogeneity||Degree of variability with an analyzed subgroup|
|Sample size limitation||In event of lack of a difference between subgroups, what is the power to detect a clinically meaningful difference?|
|Confounding||Was a multivariate analysis done to assess whether an observed difference was independently associated with the factor of interest?|
Difference between Stage Classification and Prognosis
Appropriate Use of Prognosis from the IASLC Database
IASLC Staging and Prognostic Factors Committee
Advisory Board of the IASLC Mesothelioma Domain
Advisory Board of the IASLC Thymic Malignancies Domain
Advisory Board of the IASLC Esophageal Cancer Domain
Participating Institutions in the New IASLC Lung Cancer Staging Project
T Descriptors Subcommittee
N Descriptors Subcommittee
M Descriptors Subcommittee
Validation and Methodology Subcommittee
Prognostic Factors Subcommittee
Neuroendocrine Tumors Subcommittee
Biologic Factors Subcommittee
Ad Hoc Workgroups
T Coding and Size Measurement in Preinvasive and Lepidic Adenocarcinoma Workgroup
Multiple Pulmonary Sites of Involvement Workgroup
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Disclosure: Dr. Peake reports personal fees from Roche Pharmaceuticals, Bristol-Myers Squibb Oncology, and Lilly Pharmaceuticals outside the submitted work. The remaining authors declare no conflict of interest.
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