The Stage Classification of Lung Cancer Frank C. Detterbeck, MD, FCCP, Pieter E. Postmus, MD, PhD, FCCP, Lynn T. Tanoue, MD, FCCP CHEST Volume 143, Issue 5, Pages e191S-e210S (May 2013) DOI: 10.1378/chest.12-2354 Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 1 [Sections 2.0, 3.0, 6.2] Definitions for TNM descriptors. Adapted with permission from Detterbeck et al.13 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 2 [Section 3.0] Median survival (mo) of patients in the International Association for the Study of Lung Cancer database with single lymph node zone involvement.8 NS = not significant. CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 3 [Section 3.1] The International Association for the Study of Lung Cancer lymph node map, including the proposed grouping of lymph node stations into zones for the purposes of prognostic analyses. Ao = aorta; Eso = esophagus; L = left side; mPA = main pulmonary artery; R = right side; SVC = superior vena cava; T = trachea. Reproduced with permission from Rusch et al.24 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 4 [Section 3.1] A-F, Illustrations of how the International Association for the Study of Lung Cancer lymph node map can be applied to clinical staging by CT scan in axial (A-C), coronal (D), and sagittal (E, F) views. A and B, The border between the right- and left-side paratracheal region is shown. Az = azygous vein; InV = innominate vein; LLLB = left lower lobe bronchus; Lt = left; MB = mainstem bronchus; PA = pulmonary artery; Rt = right; SCA = subclavian artery; SPV = superior pulmonary vein. See Figure 2 legend for expansion of other abbreviations. Reproduced with permission from Rusch et al.24 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 5 [Section 5.0] Stage groups according to TNM descriptor and subgroups. Reproduced with permission from Detterbeck et al.13 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 6 [Section 5.0] TNM elements included in stage groups. Adapted with permission from Detterbeck et al.13 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 7 [Section 5.0] Graphic illustration of stages 0, I, and II. Reproduced with permission from Detterbeck et al.13 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 8 [Section 5.0] Graphic illustration of stages IIIA and IIIB. Reproduced with permission from Detterbeck et al.13 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 9 [Section 5.0] Graphic illustration of stage IV. Reproduced with permission from Detterbeck et al.13 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 10 [Section 6.1] Definition of multiple primary lung cancers. CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 11 [Section 7.0] Types of staging assessments. CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 12 [Sections 7.0, 8.0] Additional descriptors. CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 13 [Section 10.0] Median survival (mo) of the clinical T descriptor cohort (cN0, cM0) in the International Association for the Study of Lung Cancer database according to the geographic region and database type. Aus = Australia; Clin = clinical.2 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 14 [Section 10.0] Median survival (mo) of the clinical N descriptor cohort (cTAny, cM0) in the International Association for the Study of Lung Cancer database according to the geographic region and database type. See Figure 13 legend for expansion of abbreviations.2 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 15 [Section 10.0] Treatment given (as percentage of total) in NCDB (2004-2007) to patients with non-small cell lung cancer (n = 22,044) whose stage grouping shifted from the designation in the sixth to the seventh edition of the Lung Cancer Stage Classification system. Ch = chemotherapy; ChRT = chemoradiotherapy; ChRT-S = chemoradiotherapy then surgery; Ch-S = chemotherapy then surgery; NCDB = National Cancer Database; No Tmt = no treatment; RT = radiotherapy; S = surgery alone; S-Ch = surgery then chemotherapy; S-ChRT = surgery then chemoradiotherapy; S-RT = surgery then radiotherapy. See Figure 4 legend for expansion of other abbreviations. Reproduced with permission from Boffa et al.110 CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions
Figure 16 [Section 11.0] ACCP suggestions to avoid ambiguities in the IASLC, UICC, and AJCC stage classification systems. CHEST 2013 143, e191S-e210SDOI: (10.1378/chest.12-2354) Copyright © 2013 The American College of Chest Physicians Terms and Conditions