The IASLC Lung Cancer Staging Project The 8th Edition

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Presentation transcript:

The IASLC Lung Cancer Staging Project The 8th Edition

TNM Classification Union for International Cancer Control IASLC Lung Cancer Staging Project

The New IASLC Database (1999-2010) Europe 46,560 Asia 41,705 North America 4,660 Australia 1,593 South America 190 70,967 NSCLC 6,189 SCLC J Thorac Oncol 2014;9: 1618–1624

Stage Distribution by Region NSCLC SCLC Stage Distribution by Region Stage I II III IV J Thorac Oncol 2014;9: 1618–1624

7th edition 8th edition J Thorac Oncol 2014;9: 1618–1624

J Thorac Oncol 2014;9: 1618–1624

T

J Thorac Oncol 2015;10: 990–1003

J Thorac Oncol 2015;10: 990–1003

A comparison of T2a less than 3 cm (T2a by descriptor other than size, i.e., visceral pleura invasion) versus cases of similar size (T1b 2–3 cm) indicated that T2a cases are appropriately in a higher risk category Pathologically and clinically staged tumors greater than 5 cm but equal to or less than 7 cm aligned better with a T3 prognosis than with a T2b Tumors classified as T3 by size greater than 7cm had a survival similar to that of T4 tumors

J Thorac Oncol 2015;10: 990–1003

J Thorac Oncol 2015;10: 990–1003

Involvement of main bronchus, regardless of distance to carina, does not seem to increase risk after adjusting for tumor size T2 main bronchus is similar to other T2 cases, and T3 main bronchus does not show significant increased risk over T2

T4 Delete

J Thorac Oncol 2015;10: 990–1003

J Thorac Oncol 2015;10: 990–1003

J Thorac Oncol 2015;10: 990–1003

J Thorac Oncol 2015;10: 990–1003

Overall Survival According to Clinical N (cN) Categories J Thorac Oncol 2015;10: 1675–1684

J Thorac Oncol 2015;10: 1675–1684

J Thorac Oncol 2015;10: 1675–1684

J Thorac Oncol 2015;10: 1675–1684

pN2 single (pN2a) pN2 multiple (pN2b) pN1 single (pN1a) pN1 multiple (pN1b)

M1a

J Thorac Oncol 2015;10: 1515–1522

Adrenal Vertebra Liver

J Thorac Oncol 2015;10: 1515–1522

J Thorac Oncol 2015;10: 1515–1522

The site of the metastasis was not prognostic for single or multiple lesions within a single organ

J Thorac Oncol 2015;10: 1515–1522

“oligometastatic disease” The concept of “oligometastatic disease”

Recommendations 1. Maintain the use of the current M1a category, including any of the following descriptors: (a) pleural/pericardial effusion, (b) contralateral/bilateral tumor nodules, (c) pleural/pericardial nodules, and (d) multiple M1a descriptors. J Thorac Oncol 2015;10: 1515–1522

2. Reclassify the current M1b category for patients with a single metastatic lesion in a single organ site, for example: (a) brain, (b) liver, (c) bone, (d) distant lymph node/ skin/peritoneum, and (e) adrenal gland. Categorization of localization of single lesions in a single organ should be prospectively tested based on the individually involved organ. J Thorac Oncol 2015;10: 1515–1522

CT T NSCLC - RUL M MRI Brain Metastasis

3. Introduce the new M1c category for patients with (a) multiple lesions in a single organ or (b) multiple lesions in multiple organs. Comparable with the data now available for the influence of tumor volume in the T descriptors, it is recommended to prospectively register in detail (a) the number of metastatic lesions and (b) the number of involved organs. J Thorac Oncol 2015;10: 1515–1522

T N M T1a (0-1) M1a T1b (1-2) M1b T1c (2-3) M1c T2a (3-4) T2b (4-5) T4 >7, diaphragm

The IASLC Lung Cancer Staging Project The 8th Edition