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J Thorac Oncol. 2016 Sep;11(9):1433-46. doi: 10.1016/j.jtho.2016.06.028. Epub 2016 Jul 21.

The IASLC Lung Cancer Staging Project: Methodology and Validation Used in the Development of Proposals for Revision of the Stage Classification of NSCLC in the Forthcoming (Eighth) Edition of the TNM Classification of Lung Cancer.

Collaborators (230)

Goldstraw P, Rami-Porta R, Asamura H, Ball D, Beer DG, 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, Cavaco FA, Barrera EA, Arca JA, Lamelas IP, Obrer AA, Jorge RG, Ball D, Bascom GK, Orozco AI, Castro MA, Blum MG, Chimondeguy D, Cvijanovic V, Defranchi S, de Olaiz Navarro B, Campuzano IE, Vidueira IM, Araujo EF, García FA, Fong KM, Corral GF, González SC, Gilart JF, Arangüena LG, Barajas SG, Girard P, Goksel T, Budiño MT, Casaurrán GG, Blanco JA, Hernández JH, Rodríguez HH, Collantes JH, Heras MI, Elena JM, Jakobsen E, Kostas S, Atance PL, Ares AN, Liao M, Losanovscky M, Lyons G, Magaroles R, De Esteban Júlvez L, Gorospe MM, McCaughan B, Kennedy C, Íñiguez RM, Sorribes LM, Gozalo SN, de Arriba CÁ, Delgado MN, Alarcón JP, Cuesta JC, Park JS, Pass H, Fernández MJ, Rosenberg M, Ruffini E, Rusch V, de Cos Escuín JS, Vinuesa AS, Mitjans MS, Strand TE, Subotic D, Swisher S, Terra R, Thomas C, Tournoy K, Van Schil P, Velasquez M, Wu YL, Yokoi K, Rami-Porta R, Ball D, Bolejack V, Crowley J, Giroux DJ, Kim J, Lyons G, Rice T, Suzuki K, Thomas CF Jr, Travis WD, Wu YL, Asamura H, Ball D, Chansky K, Crowley J, Goldstraw P, Rusch V, van Schil P, Vansteenkiste J, Watanabe H, Wu YL, Zielinski M, Eberhardt W, Chansky K, Crowley J, Kim YT, Kondo H, Mitchell A, Turrisi A, Groome P, Detterbeck F, Bolejack V, Crowley J, Kennedy C, Krasnik M, Peake M, Sculier JP, Chansky K, Crowley J, Giroux DJ, Gleeson F, van Meeerbeeck J, Travis WD, Asamura H, Chansky K, Crowley J, Giroux DJ, Nicholson A, Beyruti R, Chansky K, Crowley J, Kubota K, Turrisi A, Tsao MS, Beer DG, Crowley J, Wu YL, Travis WD, Asamura H, Bankier A, Beasley MB, Detterbeck F, Flieder DB, Goo JM, MacMahon H, Naidich D, Nicholson A, Powell CA, Prokop M, Rami-Porta R, Rusch V, van Schil P, Yatabe Y, Detterbeck F, Arenberg DA, Asamura H, Bolejack V, Crowley J, Donington JS, Franklin WA, Girard N, Marom EM, Mazzone PJ, Nicholson AG, Rusch VW, Tanoue LT, Travis WD.

Author information

Department of Surgery, Yale University, New Haven, Connecticut. Electronic address:
Cancer Research And Biostatistics, Seattle, Washington.
Queen's Cancer Research Institute, Kingston, Ontario, Canada.
University of Sydney, Strathfield Private Hospital Campus, Strathfield, New South Wales, Australia.
Gentofte University Hospital, Copenhagen, Denmark.
University of Leicester, Leicester, United Kingdom.
Thoracic Surgery Service, Hospital Universitari Mutua Terrassa and Centros de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.



Stage classification provides a consistent language to describe the anatomic extent of disease and is therefore a critical tool in caring for patients. The Staging and Prognostic Factors Committee of the International Association for the Study of Lung Cancer developed proposals for revision of the classification of lung cancer for the eighth edition of the tumor, node, and metastasis (TNM) classification, which takes effect in 2017.


An international database of 94,708 patients with lung cancer diagnosed in 1999-2010 was assembled. This article describes the process and statistical methods used to refine the lung cancer stage classification.


Extensive analysis allowed definition of tumor, node, and metastasis categories and stage groupings that demonstrated consistent discrimination overall and within multiple different patient cohorts (e.g., clinical or pathologic stage, R0 or R-any resection status, geographic region). Additional analyses provided evidence of applicability over time, across a spectrum of geographic regions, histologic types, evaluative approaches, and follow-up intervals.


An extensive analysis has produced stage classification proposals for lung cancer with a robust degree of discriminatory consistency and general applicability. Nevertheless, external validation is encouraged to identify areas of strength and weakness; a sound validation should have discriminatory ability and be based on an independent data set of adequate size and sufficient follow-up with enough patients for each subgroup.


Lung cancer; Lung cancer staging; NSCLC; Prognosis; TNM classification; Validation

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