Implications of the eighth edition of the TNM proposal: Invasive versus total tumor size for the T descriptor in pathologic stage I-IIA lung adenocarcinoma Journal Article


Authors: Kameda, K.; Eguchi, T.; Lu, S.; Qu, Y.; Tan, K. S.; Kadota, K.; Adusumilli, P. S.; Travis, W. D.
Article Title: Implications of the eighth edition of the TNM proposal: Invasive versus total tumor size for the T descriptor in pathologic stage I-IIA lung adenocarcinoma
Abstract: Introduction: The eighth edition of the TNM staging system included the proposal that the T descriptor be determined according to the invasive component, excluding lepidic component, for nonmucinous lung adenocarcinomas. We sought to conduct a clinicopathologic comparative analysis of the newly proposed classification using invasive size versus total tumor size. Methods: Patients who underwent lung resection for primary lung adenocarcinoma with pathologic stage (p-Stage) I-IIA (based on total size [t]) were reviewed (n = 1704). Pathologic invasive size was measured, and tumors were reclassified using invasive size (i). Cumulative incidence of recurrence and lung cancer–specific cumulative incidence of death were analyzed using a competing-risks approach. Prognostic discrimination by p-Stage(t) and p-Stage(i) was evaluated using a concordance index (C-index). Results: The use of invasive size resulted in downstaging in 377 of 1704 patients (22%), with twice as many patients with p-Stage IA1 (IA1[i] versus IA1[t]: 389 [23%] versus 195 [11%]). However, outcomes were similar between the two groups (IA1[i] versus IA1[t]: 5-year cumulative incidence of recurrence, 11% versus 13%; 5-year lung cancer–specific cumulative incidence of death, 5% versus 7%). Prognostic discrimination by p-Stage(i) was better than by p-Stage(t) (C-index for p-Stage[i] versus p-Stage[t]: recurrence, 0.614 versus 0.593; lung cancer–specific death, 0.634 versus 0.621). Conclusions: When invasive size, rather than total size, was used for the T descriptor, a larger number of patients were classified with a favorable prognosis (p-Stage IA1) and better prognostic discrimination of p-Stage I-IIA nonmucinous lung adenocarcinomas was achieved. © 2018 International Association for the Study of Lung Cancer
Keywords: recurrence; lung adenocarcinoma; invasive tumor size; consolidation tumor size; lung cancer–specific death
Journal Title: Journal of Thoracic Oncology
Volume: 13
Issue: 12
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2018-12-01
Start Page: 1919
End Page: 1929
Language: English
DOI: 10.1016/j.jtho.2018.08.2022
PUBMED: 30195703
PROVIDER: scopus
PMCID: PMC6309787
DOI/URL:
Notes: Article -- Export Date: 3 December 2018 -- Source: Scopus
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MSK Authors
  1. William D Travis
    611 Travis
  2. Kyuichi Kadota
    84 Kadota
  3. Takashi   Eguchi
    71 Eguchi
  4. Kay See   Tan
    117 Tan
  5. Shaohua   Lu
    23 Lu
  6. Yang Qu
    3 Qu
  7. Koji Kameda
    9 Kameda