Abstract
Since 1966 the classification of anatomic extent of lung cancer, based on the primary tumour (T), the loco-regional lymph nodes (N), and the metastases (M) has been used in the management of lung cancer patients. Developed by Pierre Denoix, it was adopted by the Union for International Cancer Control and the American Joint Committee on Cancer. Clifton Mountain revised the second through the sixth editions based on a North American database of more than 5000 patients. For the seventh and the eighth editions, the International Association for the Study of Lung Cancer (IASLC) collected international databases of around 100,000 patients worldwide that allowed the introduction of innovations in both editions, namely the subdivision of the T and M categories based on tumour size and on the location and number of metastases, respectively. The revisions also showed the prognostic relevance of the quantification of nodal disease and proposed recommendations on how to measure tumour size for solid lung cancers, part-solid adenocarcinomas, and for lung cancers removed after induction therapy. Despite the innovations, prognosis based on the anatomic extent is limited, because prognosis depends on factors related to the tumour, the patient, and the environment. For the 9th edition, these factors, especially genetic biomarkers, will be combined in prognostic groups to refine prognosis at clinical and pathologic staging. To achieve this challenging objective, international cooperation is essential, and the IASLC Staging and Prognostic Factors Committee counts on it for the development of the 9th edition due to be published in 2024.
References
Brierley JD, Gospodarowicz MK, Wittekind Ch, eds. UICC TNM Classification of Malignant Tumours. Eighth edition. Oxford: Wiley Blackwell; 2017.
Amin MB, ed. AJCC Cancer Staging Manual. Eighth edition. Springer; 2017.
Rami-Porta R, ed. IASLC Staging Manual in Thoracic Oncology. North Fort Myers, FL: Editorial Rx Press; 2016.
Giroux DJ, Van Schil P, Asamura H, Rami-Porta R, Chansky K, Crowley JJ, et al. The IASLC Lung Cancer Staging Project: a renewed call to participation. J Thorac Oncol. 2018 Jun;13(6):801-809. https://doi.org/10.1016/j.jtho.2018.02.012
Goldstraw P. The history of TNM staging in lung cancer. In: Rami-Porta R (ed). IASLC Staging Manual in Thoracic Oncology, 2nd edition; North Forth Myers Editorial Rx Press; 2016: 67-78.
Goldstraw P, Crowley JJ. The International Association for the Study of Lung Cancer International Staging Project on Lung Cancer. J Thorac Oncol. 2006; 1: 281-286. https://doi.org/10.1016/S1556-0864(15)31581-1
Rami-Porta R, Bolejack V, Giroux DJ et al. The IASLC Lung Cancer Staging Project: the new database to inform the eighth edition of the TNM classification of lung cancer. J Thorac Oncol 2014; 9: 1618-1624. https://doi.org/10.1097/jto.0000000000000334
Rami-Porta R, Bolejack V, Giroux DJ, Chansky K, Crowley J, Asamura H, 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. 2014 Nov;9(11):1618-24. https://doi.org/10.1097/jto.0000000000000334
Rami-Porta R, Bolejack V, Crowley J, Ball D, Kim J, Lyons G, et al. The IASLC Lung Cancer Staging Project: proposals for the revisions of the T descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol. 2015 Jul;10(7):990-1003. https://doi.org/10.1097/jto.0000000000000559
Travis WD, Brambilla E, Noguchi M, et al. The New IASLC/ATS/ERS international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011;6:244-285. https://doi.org/10.1097/JTO.0b013e318206a221
Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart. Lyon: International Agency for Research on Cancer; 2015.
Travis WD, Asamura H, Bankier AA, Beasley MB, Detterbeck F, Flieder DB, et al. The IASLC Lung Cancer Staging Project: proposals for coding T categories for subsolid nodules and assessment of tumor size in part-solid tumors in the forthcoming eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2016 Aug;11(8):1204-1223. https://doi.org/10.1016/j.jtho.2016.03.025
Travis WD, Brambilla E, Rami-Porta R, Vallières E, Tsuboi M, Rusch V, 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: 1384-1390. https://doi.org/10.1097/jto.0b013e31818e0d9f
Taube JM, Askin FB, Brock MV, Westra W. Impact of elastic staining on the staging of peripheral lung cancers. Am J Surg Pathol. 2007 Jun;31(6):953-6. https://doi.org/10.1097/pas.0b013e31802ca413
Detterbeck FC, Nicholson AG, Franklin WA et al. The IASLC Lung Cancer Staging Project: summary of proposals for revisions of the classification of lung cancers with multiple pulmonary sites of involvement in the forthcoming eighth edition of the TNM classification. J Thorac Oncol 2016; 11: 539-650. https://doi.org/10.1016/j.jtho.2016.01.024
Detterbeck FC, Nicholson AG, Franklin WA, Marom EM, Travis WD, Girard N, et al. The IASLC Lung Cancer Staging Project: background data and proposed criteria to distinguish separate primary lung cancers from metastatic foci in patients with two lung tumors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol. 2016 May;11(5):639-650. https://doi.org/10.1016/j.jtho.2016.01.024
Detterbeck FC, Bolejack V, Arenberg DA, Crowley J, Donington JS, Franklin WA, et al. The IASLC Lung Cancer Staging Project: background data and proposals for the classification of lung cancer with separate tumor nodules in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol. 2016; 11: 681-692. https://doi.org/10.1016/j.jtho.2015.12.114
Detterbeck FC, Marom EM, Arenberg DA, Franklin WA, Nicholson AG, Travis WD, et al. The IASLC Lung Cancer Staging Project: background data and proposals for the application of TNM staging rules to lung cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic-type of involvement in the forthcoming eighth edition of the TNM classification. J Thorac Oncol 2016; 11: 666-680. https://doi.org/10.1016/j.jtho.2015.12.113
Travis WD, Giroux DJ, Chansky K, Crowley J, Asamura H, Brambilla E, et al. The IASLC Lung Cancer 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. J Thorac Oncol. 2008 Nov;3(11):1213-23. https://doi.org/10.1097/jto.0b013e31818b06e3
Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, Chansky K, 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 Dec;2(12):1067-77. https://doi.org/10.1097/jto.0b013e31815bdc0d
Vallières E, Shepherd FA, Crowley J, Van Houtte P, Postmus PE, Carney D, et al. The IASLC Lung Cancer Staging Project. Proposals regarding the relevance of the 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: 1049-1059. https://doi.org/10.1097/jto.0b013e3181b27799
Nicholson AG, Chansky K, Crowley J, Beyruti R, Kubota K, Turrisi A, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: proposals for the revision of the clinical and pathologic staging of small cell lung cancer in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol. 2016 Mar;11(3):300-11. https://doi.org/10.1016/j.jtho.2015.10.008
Rami-Porta R. Quantification of regional lymph node involvement in lung cancer. Thorax 2011; 66: 271-272. http://dx.doi.org/10.1136/thx.2010.155010
Rusch VW, Crowley J, Giroux DJ, Goldstraw P, Im JG, Tsuboi M, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classifications for lung cancer. J Thorac Oncol. 2007 Jul;2(7):603-12. https://doi.org/10.1097/jto.0b013e31807ec803
Rusch VW, Asamura H, Watanabe H, Giroux DJ, Rami-Porta R, Goldstraw P. 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 May;4(5):568-77. https://doi.org/10.1097/jto.0b013e3181a0d82e
Asamura H, Chansky K, Crowley J et al. The IASLC Lung Cancer Staging Project: proposals for the revisions of the N descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol. 2015; 10: 1675-1684. https://doi.org/10.1016/j.jtho.2015.09.009
Postmus PE, Brambilla E, Chansky K, 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: 686-693.
Eberhardt WE, Mitchell A, Crowley J, Kondo H, Kim YT, Turrisi A 3rd, et al. The IASLC Lung Cancer Staging Project: proposals for the revisions of the M descriptors in the forthcoming 8th edition of the TNM classification for lung cancer. J Thorac Oncol. 2015 Nov;10(11):1515-22. https://doi.org/10.1097/jto.0000000000000673
Dias M, Antunes A, Campainha S, Conde S, Barroso A. Prognostic impact of M descriptors of the 8th edition of TNM classification of lung cancer. J Thorac Dis 2017; 9: 685-691. https://doi.org/10.21037/jtd.2017.03.106
Dingemans A, Hendriks L, Berghmans T et al. Searching for a definition of synchronous oligometastatic (SOMD)-NSCLC: a consensus from thoracic oncology experts. J Thorac Oncol 2018; 13 (10S): S446.
Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the stage grouping in the forthcoming (8th) edition of the TNM classification of lung cancer. J Thorac Oncol. 2016 Jan;11(1):39-51. https://doi.org/10.1097/jto.0b013e31812f3c1a
Detterbeck FC, Chansky K, Groome P, Bolejack V, Crowley J, Shemanski L, et al. The IASLC Lung Cancer Staging Project: methodology and validation used in the development of proposals for revision of the stage classification of NSCLC in the forthcoming (eighth) edition of the TNM classification of lung cancer. J Thorac Oncol. 2016 Sep;11(9):1433-46. https://doi.org/10.1016/j.jtho.2016.06.028
Chansky K, Detterbeck FC, Nicholson AG, Rusch VW, Vallières E, Groome P, et al. The IASLC Lung Cancer Staging Project: external validation of the revision of the TNM stage groupings in the eighth edition of the TNM classification of lung cancer. J Thorac Oncol. 2017 Jul;12(7):1109-1121. https://doi.org/10.1016/j.jtho.2017.04.011
Greene FL, Sobin LH. A worldwide approach to the TNM staging system: collaborstive efforts of the AJCC and UICC. J Surg Oncol. 2009 Apr 1;99(5):269-72. https://doi.org/10.1002/jso.21237
Greene FL, Sobin LH. The staging of cancer: a retrospective and prospective appraisal. CA Cancer J Clin. May-Jun 2008;58(3):180-90. https://doi.org/10.3322/ca.2008.0001
Rami-Porta R, Asamura H, Brierly J, Goldstraw P. Staging, tumor profile, and prognotic groups in lung cáncer or the new Tower of Babel. J Thorac Oncol. 2016 Aug;11(8):1201-1203. https://doi.org/10.1016/j.jtho.2016.04.019
Detterbeck F. Developing a prognostic prediction model for lung cancer. In Rami-Porta R (ed). IASLC Staging Manual in Thoracic Oncology. North Fort Myers, FL: Editorial Rx Press; 2016: 237-258.
Sculier JP, Chansky K, Crowley JJ, van Meerbeeck JV, Goldstraw P. The impact of additional prognostic factors on survival and their relationship with the anatomical 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 May;3(5):457-66. https://doi.org/10.1097/jto.0b013e31816de2b8
Chansky K, Sculier JP, Crowley JJ, Giroux D, van Meerbeeck J, Goldstraw P. 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 Jul;4(7):792-801. https://doi.org/10.1097/jto.0b013e3181a7716e
![Creative Commons License](http://i.creativecommons.org/l/by/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2019 Ramón Rami-Porta