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J Thorac Oncol. 2015 Jul;10(7):990-1003. doi: 10.1097/JTO.0000000000000559.

The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer.

Collaborators (142)

Goldstraw P, Rami-Porta R, Asamura H, Ball D, Beer D, Beyruti R, Bolejack V, Chansky K, Crowley J, Detterbeck F, Eberhardt WE, Edwards J, Galateau-Sallé F, Giroux D, Gleeson F, Groome P, Huang J, Kennedy C, Kim J, Kim YT, Kingsbury L, Kondo H, Krasnik M, Kubota K, Lerut A, Lyons G, Marino M, Marom EM, van Meerbeeck J, Mitchell A, Nakano T, Nicholson AG, Nowak A, Peake M, Rice T, Rosenzweig K, Ruffini E, Rusch V, Saijo N, Van Schil P, Sculier JP, Shemanski L, Stratton K, Suzuki K, Tachimori Y, Thomas CF Jr, Travis W, Tsao MS, Turrisi A, Vansteenkiste J, Watanabe H, Wu YL, Baas P, Erasmus J, Hasegawa S, Inai K, Kernstine K, Kindler H, Krug L, Nackaerts K, Pass H, Rice D, Falkson C, Filosso PL, Giaccone G, Kondo K, Lucchi M, Okumura M, Blackstone E, Abad Cavaco F, Ansótegui Barrera E, Abal Arca J, Parente Lamelas I, Arnau Obrer A, Guijarro Jorge R, Ball D, Bascom G, Blanco Orozco A, González Castro M, Blum M, Chimondeguy D, Cvijanovic V, Defranchi S, de Olaiz Navarro B, Escobar Campuzano I, Macía Vidueira I, Fernández Araujo E, Andreo García F, Fong K, Francisco Corral G, Cerezo González S, Freixinet Gilart J, García Arangüena L, García Barajas S, Girard P, Goksel T, González Budiño M, González Casaurrán G, Gullón Blanco J, Hernández Hernández J, Hernández Rodríguez H, Herrero Collantes J, Iglesias Heras M, Izquierdo Elena J, Jakobsen E, Kostas S, León Atance P, Núñez Ares A, Liao M, Losanovscky M, Lyons G, Magaroles R, De Esteban Júlvez L, Mariñán Gorospe M, McCaughan B, Kennedy C, Melchor Íñiguez R, Miravet Sorribes L, Naranjo Gozalo S, Álvarez C, Núñez Delgado M, Padilla Alarcón J, Peñalver Cuesta J, Park J, Pass H, Pavón Fernández M, Rosenberg M, Ruffini E, Rusch V, Sánchez J, Saura Vinuesa A, Serra Mitjans M, Strand T, Subotic D, Swisher S, Terra R, Thomas C, Tournoy K, Van Schil P, Velasquez M, Wu Y, Yokoi K.

Author information

*Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, and CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain; †Cancer Research And Biostatistics, Seattle, Washington; ‡Department of Radiotherapy, Peter MacCallum Cancer Centre, Melbourne, Australia; §Department of Thoracic Surgery, Samsung Medical Center, Seoul, South Korea; ‖Department of Thoracic Surgery, Hospital Británico, Buenos Aires, Argentina; ¶Department of Thoracic Surgery, Cleveland Clinic, Cleveland, Ohio; #Department of Thoracic Surgery, Juntendo University, Tokyo, Japan; **Department of Internal Medicine and Pulmonology, Mayo Clinic, Rochester, Minnesota; ††Department of Pathology, Sloan-Kettering Cancer Center, New York, New York; ‡‡Guangdong Lung Cancer Institute, Guangdong, General Hospital & Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China; and §§Members of the IASLC Staging and Prognostic Factors Committee, Advisory Boards and Participating Institutions are listed in the Appendix.



An international database was collected to inform the 8 edition of the anatomic classification of lung cancer. The present analyses concern its primary tumor (T) component.


From 1999 to 2010, 77,156 evaluable patients, 70,967 with non-small-cell lung cancer, were collected; and 33,115 had either a clinical or a pathological classification, known tumor size, sufficient T information, and no metastases. Survival was measured from date of diagnosis or surgery for clinically and pathologically staged tumors. Tumor-size cutpoints were evaluated by the running log-rank statistics. T descriptors were evaluated in a multivariate Cox regression analysis adjusted for age, gender, histological type, and geographic region.


The 3-cm cutpoint significantly separates T1 from T2. From 1 to 5 cm, each centimeter separates tumors of significantly different prognosis. Prognosis of tumors greater than 5 cm but less than or equal to 7 cm is equivalent to T3, and that of those greater than 7 cm to T4. Bronchial involvement less than 2 cm from carina, but without involving it, and total atelectasis/pneumonitis have a T2 prognosis. Involvement of the diaphragm has a T4 prognosis. Invasion of the mediastinal pleura is a descriptor seldom used.


Recommended changes are as follows: to subclassify T1 into T1a (≤1 cm), T1b (>1 to ≤2 cm), and T1c (>2 to ≤3 cm); to subclassify T2 into T2a (>3 to ≤4 cm) and T2b (>4 to ≤5 cm); to reclassify tumors greater than 5 to less than or equal to 7 cm as T3; to reclassify tumors greater than 7 cm as T4; to group involvement of main bronchus as T2 regardless of distance from carina; to group partial and total atelectasis/pneumonitis as T2; to reclassify diaphragm invasion as T4; and to delete mediastinal pleura invasion as a T descriptor.

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