The New Tumor, Node, and Metastasis Staging System

ABSTRACT

The seventh edition of the tumor, node, and metastasis (TNM) classification is based on the proposals of the Staging Project of the International Association for the Study of Lung Cancer (IASLC). The analyses of the IASLC international database of 81,015 patients diagnosed with lung cancer between 1990 and 2000 were used to validate the TNM descriptors. The changes include: the subclassification of T1 and T2 tumors into T1a (≤2 cm) and T1b (>2 and ≤3 cm), and T2a (>3 and ≤5 cm) and T2b (>5 and ≤7 cm), respectively; the reclassification of T2 tumors >7 cm as T3; the reclassification of T4 tumors by additional nodules in the same lobe of the primary tumor as T3; the reclassification of M1 tumors by additional nodules in another ipsilateral lobe as T4; the reclassification of pleural and pericardial dissemination, and contralateral M1 nodules as M1a; and the separation of intrathoracic (M1a) and extrathoracic (M1b) metastases. Other innovations include the emphasis on the use of the TNM classification for small cell carcinoma, the inclusion of bronchopulmonary carcinoids into this staging system, the proposal of a new lymph node map, and the adoption of a new, internationally agreed definition of visceral pleura invasion. All these changes improve the separation of tumors with significantly different prognosis.

Carcinoid - non-small-cell lung cancer - small-cell lung cancer - staging - TNM classification

REFERENCES

• 1 Goldstraw P, ed. Staging Manual in Thoracic Oncology. Orange Park, FL: Editorial Rx Press; 2009
• 2 Sobin L, Gospodarowicz M, Wittekind C, eds. TNM Classification of Malignant Tumours. 7th ed. Oxford, England: Wiley-Blackwell; 2009: 138-146
• 3 Edge S B, Byrd D R, Compton C C, Fritz A G, Greene F L, Trotti III A, eds. Cancer Staging Manual. 7th ed. New York, NY: Springer; 2010: 253-270
• 4 Goldstraw P, Crowley J J. The International Association for the Study of Lung Cancer international staging project on lung cancer.  J Thorac Oncol. 2006;  1 281-286
• 5 Mountain C F. Revisions in the international system for staging lung cancer.  Chest. 1997;  111 (6) 1710-1717
• 6 Rami-Porta R, Ball D, Crowley J International Staging Committee et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the T descriptors in the forthcoming (seventh) edition of the TNM classification for lung cancer.  J Thorac Oncol. 2007;  2 (7) 593-602
• 7 Rusch V W, Crowley J, Giroux D J International Staging Committee et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classification for lung cancer.  J Thorac Oncol. 2007;  2 (7) 603-612
• 8 Rusch V W, Asamura H, Watanabe H, Giroux D J, Rami-Porta R, Goldstraw P. Members of IASLC Staging Committee . The IASLC Lung Cancer Staging Project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer.  J Thorac Oncol. 2009;  4 (5) 568-577
• 9 Postmus P E, Brambilla E, Chansky K International Association for the Study of Lung Cancer International Staging Committee et al. The IASLC Lung Cancer Staging Project: proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer.  J Thorac Oncol. 2007;  2 (8) 686-693
• 10 Goldstraw P, Crowley J, Chansky K International Association for the Study of Lung Cancer International Staging Committee et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours.  J Thorac Oncol. 2007;  2 (8) 706-714
• 11 Groome P A, Bolejack V, Crowley J J IASLC International Staging Committee et al. The IASLC Lung Cancer Staging Project: validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours.  J Thorac Oncol. 2007;  2 (8) 694-705
• 12 Shepherd F A, Crowley J, Van Houtte P International Association for the Study of Lung Cancer International Staging Committee and Participating Institutions et al. The International Association for the Study of Lung Cancer lung cancer staging project: proposals regarding the clinical staging of small cell lung cancer in the forthcoming (seventh) edition of the tumor, node, metastasis classification for lung cancer.  J Thorac Oncol. 2007;  2 (12) 1067-1077
• 13 Travis W D, Giroux D J, Chansky K International Staging Committee and Participating Institutions et al. The IASLC Lung Cancer Staging Project: proposals for the inclusion of broncho-pulmonary carcinoid tumors in the forthcoming (seventh) edition of the TNM Classification for Lung Cancer.  J Thorac Oncol. 2008;  3 (11) 1213-1223
• 14 Vallières E, Shepherd F A, Crowley J International Association for the Study of Lung Cancer International Staging Committee and Participating Institutions et al. The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer.  J Thorac Oncol. 2009;  4 (9) 1049-1059
• 15 Mountain C F, Dresler C M. Regional lymph node classification for lung cancer staging.  Chest. 1997;  111 (6) 1718-1723
• 16 Naruke T, Suemasu K, Ishikawa S. Lymph node mapping and curability at various levels of metastasis in resected lung cancer.  J Thorac Cardiovasc Surg. 1978;  76 (6) 832-839
• 17 Sculier J P, Chansky K, Crowley J J, van Meerbeeck J, Goldstraw P. International Staging Committee and Participating Institutions . The impact of additional prognostic factors on survival and their relationship with the anatomic extent of disease expressed by the 6th edition of the TNM classification of malignant tumors and the proposals for the 7th edition.  J Thorac Oncol. 2008;  3 (5) 457-466
• 18 Chansky K, Sculier J P, Crowley J J, Giroux D, Van Meerbeeck J, Goldstraw P. International Staging Committee and Participating Institutions . The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer.  J Thorac Oncol. 2009;  4 (7) 792-801
• 19 Travis W D, Brambilla E, Rami-Porta R International Staging Committee et al. Visceral pleural invasion: pathologic criteria and use of elastic stains: proposal for the 7th edition of the TNM classification for lung cancer.  J Thorac Oncol. 2008;  3 (12) 1384-1390
• 20 Rami-Porta R, Wittekind C, Goldstraw P. International Association for the Study of Lung Cancer (IASLC) Staging Committee . Complete resection in lung cancer surgery: proposed definition.  Lung Cancer. 2005;  49 (1) 25-33
• 21 Sobin L H, Wittekind C, eds. TNM Classification of Malignant Tumours. 5th ed. New York, NY: Wiley-Liss; 1997: 95
• 22 Goldstraw P. Report on the International Workshop on Intrathoracic Staging, London, October 1996.  Lung Cancer. 1997;  18 107-111
• 23 Giroux D J, Rami-Porta R, Chansky K International Association for the Study of Lung Cancer International Staging Committee et al. The IASLC Lung Cancer Staging Project: data elements for the prospective project.  J Thorac Oncol. 2009;  4 (6) 679-683