1. The IASLC Lung Cancer Staging Project The 8th Edition

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

3. 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

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

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

10. J Thorac Oncol 2014;9: 1618–1624

11. T

12. J Thorac Oncol 2015;10: 990–1003

13. J Thorac Oncol 2015;10: 990–1003

14. 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

15. J Thorac Oncol 2015;10: 990–1003

16. J Thorac Oncol 2015;10: 990–1003

17. 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

18. T4
Delete

20. J Thorac Oncol 2015;10: 990–1003

21. J Thorac Oncol 2015;10: 990–1003

22. J Thorac Oncol 2015;10: 990–1003

23. J Thorac Oncol 2015;10: 990–1003

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

29. J Thorac Oncol 2015;10: 1675–1684

30. J Thorac Oncol 2015;10: 1675–1684

31. J Thorac Oncol 2015;10: 1675–1684

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

34. M1a

35. J Thorac Oncol 2015;10: 1515–1522

37. Adrenal
Vertebra
Liver

38. J Thorac Oncol 2015;10: 1515–1522

39. J Thorac Oncol 2015;10: 1515–1522

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

41. J Thorac Oncol 2015;10: 1515–1522

42. “oligometastatic disease”
The concept of
“oligometastatic disease”

43. 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

44. 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

45. CT T
NSCLC - RUL M
MRI
Brain Metastasis

46. 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

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

48. The IASLC Lung Cancer Staging Project The 8th Edition