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

Frank C. Detterbeck, Edith M. Marom, Douglas A Arenberg, Wilbur A. Franklin, Andrew G. Nicholson, William D. Travis, Nicolas Girard, Peter J Mazzone, Jessica S Donington, Lynn T Tanoue, Valerie W Rusch, Hisao Asamura, Ramón Rami-Porta, IASLC Staging and Prognostic Factors Committee, Mirella Marino

Research output: Contribution to journalArticlepeer-review

Abstract

INTRODUCTION: Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification.

METHODS: A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification.

RESULTS: Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases.

CONCLUSION: For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.

Original languageEnglish
Pages (from-to)666-80
Number of pages15
JournalJournal of Thoracic Oncology
Volume11
Issue number5
DOIs
Publication statusPublished - May 2016

Keywords

  • Journal Article

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