الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Worldwide, lung cancer is still the leading cause of cancer-related deaths, despite screening and treatment progress in both genders. In Egypt, lung cancer is the number one malignancy causing cancer death, most patients present in the late stages.
Multidetector computed Tomography (MDCT) is performed regularly for lung cancer staging as its excellent for local staging, selects the most appropriate lymph nodes to biopsy and easily available. Mediastinoscopy is the best choice for mediastinal staging of lung cancer. The two main ways of getting biopsy samples are flexible bronchoscopy for proximal tumors and computed tomography (CT) guided lung biopsy for peripheral tumors. Tissue biopsy is the best for NSCLC diagnosis as it is informative, widely available, technically established and cost effective.
The staging system for lung cancer is very important as it can give the prognosis of the patient and the clinician can decide the treatment modalities. The 7th edition of the UICC/AJCC TNM system was formed for NSCLC in 2009 and later revised to form the new 8th edition in 2017. The changes made were like tumors measuring more than 5 cm and less than or equal to 7 cm have been reclassified as T3 tumors. Tumors measuring more than 7 cm have been reclassified as T4 tumors. Other changes include, lesions involving a main bronchus, regardless of the distance from the carina, are T2 tumors and diaphragmatic invasion is now classified as T4 disease in TNM 8th edition. In TNM 8th edition, partial and complete forms of lung atelectasis and pneumonitis are all T2 lesions. In 8th Edition, intrathoracic metastasis retains the M1a designation, but the extra thoracic metastasis group has been split into M1b (single extra thoracic metastasis in a single distant organ) and M1c (multiple extra thoracic metastases in one or more distant organs) due to disparities in patient survival. There were no changes in the N component. In the staging separation of T1 tumors into T1a, T1b, and T1c components has led to three new stages—IA1, IA2, and IA3, respectively. A new stage group, stage IIIC, has been formed to include locally advanced T3 and T4 tumors with N3 disease but no metastasis, Changes to stage IV single metastasis to a single organ stage IVA, multiple distant metastases in a single organ or multiple organs stage IVB.
The purpose of this study was to evaluate the discriminatory ability of the revised 8th edition over the 7th edition in terms of prognostic accuracy and treatment guidelines. It was a retrospective study, we had 222 NSCLC patients they were classified with the AJCC TNM 7th edition and then reclassified with the AJCC TNM 8th edition to enable the comparison.
Our results indicated that the mean age of diagnosis was about 60years with male predominance. The overall survival was not statistically significant between the older or younger than 60 years, neither between men nor women. The main symptoms were cough and chest pain. Main histology seen was adenocarcinoma though not statistically significance against other histologies in overall survival.
The N component was found to be an independent prognostic factor to overall survival as it was found to be significant. The larger the N component the more likely the patient has advanced disease with poor prognosis.
Majority of our patients presented with very advanced disease with a median overall survival of 7.1 months. We found that the T component was able to predict survival the higher the T stage the worse the prognosis. Ideally if presented earlier the more demarcation of the T component would be able to predict survival after surgery better especially in the more demarcated 8th edition. Although only 6.8% of our patients had surgery. Similarly, few patients received chemoradiation (5.9%), majority received palliative radiotherapy to the sites of metastasis. Majority received chemotherapy.