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Semin Respir Crit Care Med
DOI: 10.1055/a-2716-4877
Review Article

Ninth Edition of the Tumor, Node, and Metastasis Classification of Lung Cancer

Autor*innen

  • Kwun M. Fong

    1   Department of Thoracic Medicine, The Prince Charles Hospital, University of Queensland Thoracic Research Centre, Brisbane, Australia

  • Gerry Olive

    1   Department of Thoracic Medicine, The Prince Charles Hospital, University of Queensland Thoracic Research Centre, Brisbane, Australia

  • Henry M. Marshall

    1   Department of Thoracic Medicine, The Prince Charles Hospital, University of Queensland Thoracic Research Centre, Brisbane, Australia

  • Ramon Rami-Porta

    2   Department of Thoracic Surgery, University of Barcelona, Hospital Universitari Mutua Terrassa, Terrassa, Barcelona, Spain
    3   Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain

  • Frank Detterbeck

    4   Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut

Funding None.
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Abstract

This paper reviews the development of the current edition (Ninth) of the Tumor, Node, and Metastasis (TNM) classification of lung cancer. This classification was proposed from the analyses of a global database of 124,581 patients diagnosed between 2011 and 2019 established by The International Association of the Study of Lung Cancer. Overall survival was calculated using the Kaplan–Meier method, and prognosis assessed using multivariable-adjusted Cox proportional hazards regression to guide proposed changes to the Eighth Edition TNM classification. The innovations in the Ninth Edition TNM are: the T categories remain the same as in the Eighth Edition but descriptors previously considered separately were transferred to the official list of descriptors; the N2 category was subdivided into N2a (involvement of a single N2 station) and N2b (involvement of multiple N2 stations); the M1c category was subdivided into M1c1 (multiple extrathoracic metastases in a single organ system) and M1c2 (multiple extrathoracic metastases in multiple organ systems); and tumor cells spread through air spaces was introduced as an additional pathological descriptor. The Ninth Edition TNM classification of lung cancer aids in the understanding of the prognostic relevance of the anatomical extent of lung cancer but requires thorough clinical and pathological evaluations to benefit from the changes in clinical practice and in research.

Keywords

lung cancer - lung cancer stages - nonsmall cell lung cancer - TNM classification


Publikationsverlauf

Eingereicht: 02. Mai 2025

Angenommen: 03. Oktober 2025

Artikel online veröffentlicht:
13. November 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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