Clinical Severity Staging System for Lung Cancer of Feinstein and Wells

 

Clinical Severity Stages

 

Stage A: Asymptomatic

(1) no symptoms attributable to lung cancer

(2) past episode of 1 or more pulmonic symptoms but currently free of these symptoms

 

Stage B: Pulmonic Symptoms and/or Systemic Symptoms Only

(1) pulmonic symptoms attributable to the lung cancer

(1a) bronchial symptoms: recent cough, change in chronic cough, hemoptysis, subjective wheezing

(1b) parenchymal symptoms: dyspnea, clinical manifestations of pulmonary infection, particularly pneumonia (presume associated with bronchial obstruction due to tumor effect)

(1c) parietal symptoms: pleuritic or nonpleuritic chest pain in the absence of a localized chest wall lesion

(2) systemic symptoms

(2a) general systemic symptoms: anorexia or minor weight loss

(2b) paraneoplastic symptoms: hypertrophic pulmonary osteopathy, inappropriate ADH secretion, etc.

 

Stage C: Regional and/or Mediastinal Metastatic Symptoms and/or Major Weight Loss

(1) regional symptoms attributable to metastasis or local extension of tumor

(1a) Horner syndrome

(1b) brachial plexus or peripheral arm nerve dysfunction

(1c) chest wall symptoms with tumor involvement of vertebra, rib, and/or muscle

(2) mediastinal symptoms attributable to metastasis or local extension

(2a) superior vena cava syndrome

(2b) dysphagia

(2c) hoarseness with a non-moving vocal cord

(3) major weight loss

(3a) nondeliberate weight loss of 10-19% of usual body weight in < 6 months

(3b) loss of >= 20% of body weight in >= 6 months

 

Stage D: Distant Metastatic Symptoms and/or Extreme Weight Loss and/or Severe Dyspnea

(1) distant metastatic symptoms attributable to the tumor metastasis

(1a) symptomatic involvement of the CNS

(1b) metastasis to bone, liver, adrenal gland, etc.

(1c) metastasis to any anatomic site not in direct continuity with the thorax

(2) severe weight loss

(2a) cachexia

(2b) nondeliberate weight loss of >= 20% of usual body weight in < 6 months

(3) extreme dyspnea

(3a) rapidly progressive dyspnea attributable to the lung cancer with air hunger, respiratory distress and/or occurrence at rest in the absence of pleuritic chest pain, superior vena cava syndrome, tracheal obstruction or other explanation

 

Stage E: Prognostic Co-Morbidity and/or Severe Tumor Effects

(1) prognostic co-morbidity with prognosis as life-threatening as the lung cancer:

(1a) history of multiple myocardial infarctions

(1b) severe congestive heart failure

(1c) intractable hepatic decompensation

(1d) another metastatic cancer

(2) severe tumor effects:

(2a) rapidly progressive mental obtundation from CNS metastasis

(2b) severe dyspnea due to progressive tracheal obstruction

(2c) functional involvement of 2 or more distinctly different topographic regions

(2d) rapidly progressive superior vena cava syndrome

 

The clinical severity for a patient is assigned based on the highest stage (working backwards from E to A) for which there is a matching sign or symptom.

 

Composite Clinical Severity and TNM Stage

Clinical Severity Stage	TNM I	TNM II	TNM IIIA	TNM IIIB	TNM IV
A	alpha	beta	gamma	gamma	delta
B	beta	gamma	gamma	gamma	delta
C	gamma	gamma	gamma	delta	delta
D	delta	delta	delta	delta	delta
E	delta	delta	epsilon	epsilon	epsilon

 

 

CST Stage	Median Survival in Months	Percent with 6 Month Survival	Percent with 1 Year Survival	Percent with 5 Year Survival
alpha	28.7	86%	75%	27%
beta	17.5	83%	62%	25%
gamma	7.7	58%	36%	6%
delta	3.3	30%	10%	1%
epsilon	0.7	4%	2%	0%