The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for revision of the TNM stage groups in the forthcoming (ninth) edition of the TNM Classification for Lung Cancer Journal Article


Authors: Rami-Porta, R.; Nishimura, K. K.; Giroux, D. J.; Detterbeck, F.; Cardillo, G.; Edwards, J. G.; Fong, K. M.; Giuliani, M.; Huang, J.; Kernstine, K. H. Sr; Marom, E. M.; Nicholson, A. G.; Van Schil, P. E.; Travis, W. D.; Tsao, M. S.; Watanabe, S. I.; Rusch, V. W.; Asamura, H.; Members of the IASLC Staging and Prognostic Factors Committee and of the Advisory Boards; and Participating Institutions
Contributors: Rimner, A.; Chang, J.; Rekhtman, N.; Rocco, G.; Simone, C. B. 2nd; Sauter, J.
Article Title: The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for revision of the TNM stage groups in the forthcoming (ninth) edition of the TNM Classification for Lung Cancer
Abstract: Introduction: The TNM classification of lung cancer is periodically revised. The International Association for the Study of Lung Cancer collected and analyzed a new database to inform the forthcoming ninth edition of the TNM classification. The results are herewith presented. Methods: After exclusions, 76,518 patients from a total of 124,581 registered patients were available for analyses: 58,193 with clinical stage, 39,192 with pathologic stage, and 62,611 with best stage NSCLC. The proposed new N2 subcategories (N2a, involvement of single ipsilateral mediastinal or subcarinal nodal station, and N2b, involvement of multiple ipsilateral mediastinal nodal stations with or without involvement of the subcarinal nodal station) and the new M1c subcategories (M1c1, multiple extrathoracic metastases in one organ system, and M1c2, multiple extrathoracic metastases in multiple organ systems) were considered in the survival analyses. Several potential stage groupings were evaluated, using multiple analyses, including recursive partitioning, assessment of homogeneity within and discrimination between potential groups, clinical and statistical significance of survival differences, multivariable regression, and broad assessment of generalizability. Results: T1N1, T1N2a, and T3N2a subgroups are assigned to IIA, IIB, and IIIA stage groups, respectively. T2aN2b and T2bN2b subgroups are assigned to IIIB. M1c1 and M1c2 remain in stage group IVB. Analyses reveal consistent ordering, discrimination of prognosis, and broad generalizability of the proposed ninth edition stage classification of lung cancer. Conclusions: The proposed stages for the ninth edition TNM improve the granularity of nomenclature about anatomic extent that has benefits as treatment approaches become increasingly differentiated and complex. © 2024 International Association for the Study of Lung Cancer
Keywords: adult; middle aged; survival analysis; major clinical study; overall survival; neoadjuvant therapy; cancer staging; metastasis; lung cancer; histology; survival time; prognostic factors; kaplan meier method; tnm classification; non small cell lung cancer; cancer prognosis; lung cancer prognosis; human; male; female; article; thoracic metastasis; lung cancer stage classification; lung cancer stages
Journal Title: Journal of Thoracic Oncology
Volume: 19
Issue: 7
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2024-07-01
Start Page: 1007
End Page: 1027
Language: English
DOI: 10.1016/j.jtho.2024.02.011
PUBMED: 38447919
PROVIDER: scopus
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PDF -- Other associations featuring MSK group contributors are listed in the publication's appendix, located on the PDF -- Source: Scopus
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MSK Authors
  1. Natasha Rekhtman
    434 Rekhtman
  2. Valerie W Rusch
    869 Rusch
  3. James Huang
    215 Huang
  4. William D Travis
    749 Travis
  5. Andreas Rimner
    527 Rimner
  6. Jason Chih-Peng Chang
    141 Chang
  7. Jennifer Lynn Sauter
    129 Sauter
  8. Gaetano Rocco
    132 Rocco
  9. Charles Brian Simone
    194 Simone