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J Thorac Oncol. 2016 May;11(5):666-680. doi: 10.1016/j.jtho.2015.12.113. Epub 2016 Mar 3.

The IASLC Lung Cancer Staging Project: Background Data and Proposals for the Application of TNM Staging Rules to Lung Cancer Presenting as Multiple Nodules with Ground Glass or Lepidic Features or a Pneumonic Type of Involvement in the Forthcoming Eighth Edition of the TNM Classification.

Author information

1
Department of Surgery, Yale University, New Haven, Connecticut. Electronic address: frank.detterbeck@yale.edu.
2
Department of Diagnostic Imaging, Tel-Aviv University, Ramat Gan, Israel.
3
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
4
Department of Pathology, University of Colorado, Denver, Colorado.
5
Department of Histopathology, Royal Brompton and Harefield National Health Service Foundation Trust and Imperial College, London, United Kingdom.
6
Department of Pathology, Sloan-Kettering Cancer Center, New York, New York.
7
Respiratory Medicine Service, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France.
8
Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
9
Department of Thoracic Surgery, New York University, New York, New York.
10
Department of Internal Medicine, Yale University, New Haven, Connecticut.
11
Thoracic Surgery Service, Sloan-Kettering Cancer Center, New York, New York.
12
Division of Thoracic Surgery, Keio University, School of Medicine, Tokyo, Japan.
13
Thoracic Surgery Service, Hospital Universitari Mutua Terrassa; Centros de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.

Abstract

INTRODUCTION:

Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification.

METHODS:

A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification.

RESULTS:

Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases.

CONCLUSION:

For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.

KEYWORDS:

Lung cancer; Lung cancer staging; Multiple tumors; Non–small cell lung cancer; TNM classification

PMID:
26940527
DOI:
10.1016/j.jtho.2015.12.113
[Indexed for MEDLINE]
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