The International Association for the Study of Lung Cancer lung cancer staging project: Proposals for revision of the classification of residual tumor after resection for the forthcoming (ninth) edition of the TNM classification of lung cancer Journal Article


Authors: Detterbeck, F. C.; Ostrowski, M.; Hoffmann, H.; Rami-Porta, R.; Osarogiagbon, R. U.; Donnington, J.; Infante, M.; Marino, M.; Marom, E. M.; Nakajima, J.; Nicholson, A. G.; van Schil, P.; Travis, W. D.; Tsao, M. S.; Edwards, J. G.; Asamura, H.; and the Members of the Staging and Prognostic Factors Committee and Advisory Boards
Contributors: Rusch, V.; Huang, J.; 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 classification of residual tumor after resection for the forthcoming (ninth) edition of the TNM classification of lung cancer
Abstract: Introduction: The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain. Methods: This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders. Results: Consistent discrimination between complete, uncertain, and incomplete resection is revealed with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggest retaining all descriptors but with clarifications to address ambiguities. Conclusion: On the basis of this review, the R-classification for the ninth edition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application and further research. © 2024 International Association for the Study of Lung Cancer
Keywords: lung cancer; surgery; residual disease; complete resection
Journal Title: Journal of Thoracic Oncology
Volume: 19
Issue: 7
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2024-07-01
Start Page: 1052
End Page: 1072
Language: English
DOI: 10.1016/j.jtho.2024.03.021
PUBMED: 38569931
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
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  1. Natasha Rekhtman
    434 Rekhtman
  2. Valerie W Rusch
    869 Rusch
  3. James Huang
    216 Huang
  4. William D Travis
    750 Travis
  5. Andreas Rimner
    527 Rimner
  6. Jason Chih-Peng Chang
    142 Chang
  7. Jennifer Lynn Sauter
    129 Sauter
  8. Gaetano Rocco
    135 Rocco
  9. Charles Brian Simone
    198 Simone