The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer
Wilfried E E Eberhardt, Alan Mitchell, John Crowley, Haruhiko Kondo, Young Tae Kim, Andrew Turrisi 3rd, Peter Goldstraw, Ramon Rami-Porta, International Association for Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions, Peter Goldstraw, Ramón Rami-Porta, Hisao Asamura, David Ball, David Beer, Ricardo Beyruti, Vanessa Bolejack, Kari Chansky, John Crowley, Frank Detterbeck, Wilfried Ernst Erich Eberhardt, John Edwards, Françoise Galateau-Sallé, Dorothy Giroux, Fergus Gleeson, Patti Groome, James Huang, Catherine Kennedy, Jhingook Kim, Young Tae Kim, Laura Kingsbury, Haruhiko Kondo, Mark Krasnik, Kaoru Kubota, Antoon Lerut, Gustavo Lyons, Mirella Marino, Edith M Marom, Jan van Meerbeeck, Alan Mitchell, Takashi Nakano, Andrew G Nicholson, Anna Nowak, Michael Peake, Thomas Rice, Kenneth Rosenzweig, Enrico Ruffini, Valerie Rusch, Nagahiro Saijo, Paul Van Schil, Jean-Paul Sculier, Lynn Shemanski, Kelly Stratton, Kenji Suzuki, Yuji Tachimori, Charles F Thomas Jr, William Travis, Ming S Tsao, Andrew Turrisi, Johan Vansteenkiste, Hirokazu Watanabe, Yi-Long Wu, Paul Baas, Jeremy Erasmus, Seiki Hasegawa, Kouki Inai, Kemp Kernstine, Hedy Kindler, Lee Krug, Kristiaan Nackaerts, Harvey Pass, David Rice, Conrad Falkson, Pier Luigi Filosso, Giuseppe Giaccone, Kazuya Kondo, Marco Lucchi, Meinoshin Okumura, Eugene Blackstone, F Abad Cavaco, E Ansótegui Barrera, J Abal Arca, I Parente Lamelas, A Arnau Obrer, R Guijarro Jorge, D Ball, G K Bascom, A I Blanco Orozco, M A González Castro, M G Blum, D Chimondeguy, V Cvijanovic, S Defranchi, B de Olaiz Navarro, I Escobar Campuzano, I Macía Vidueira, E Fernández Araujo, F Andreo García, K M Fong, G Francisco Corral, S Cerezo González, J Freixinet Gilart, L García Arangüena, S García Barajas, P Girard, T Goksel, M T González Budiño, G González Casaurrán, J A Gullón Blanco, J Hernández Hernández, H Hernández Rodríguez, J Herrero Collantes, M Iglesias Heras, J M Izquierdo Elena, E Jakobsen, S Kostas, P León Atance, A Núñez Ares, M Liao, M Losanovscky, G Lyons, R Magaroles, L De Esteban Júlvez, M Mariñán Gorospe, B McCaughan, C Kennedy, R Melchor Íñiguez, L Miravet Sorribes, S Naranjo Gozalo, C Álvarez de Arriba, M Núñez Delgado, J Padilla Alarcón, J C Peñalver Cuesta, J S Park, H Pass, M J Pavón Fernández, M Rosenberg, E Ruffini, V Rusch, J Sánchez de Cos Escuín, A Saura Vinuesa, M Serra Mitjans, T E Strand, D Subotic, S Swisher, R Terra, C Thomas, K Tournoy, P Van Schil, M Velasquez, Y L Wu, K Yokoi, Wilfried E E Eberhardt, Alan Mitchell, John Crowley, Haruhiko Kondo, Young Tae Kim, Andrew Turrisi 3rd, Peter Goldstraw, Ramon Rami-Porta, International Association for Study of Lung Cancer Staging and Prognostic Factors Committee, Advisory Board Members, and Participating Institutions, Peter Goldstraw, Ramón Rami-Porta, Hisao Asamura, David Ball, David Beer, Ricardo Beyruti, Vanessa Bolejack, Kari Chansky, John Crowley, Frank Detterbeck, Wilfried Ernst Erich Eberhardt, John Edwards, Françoise Galateau-Sallé, Dorothy Giroux, Fergus Gleeson, Patti Groome, James Huang, Catherine Kennedy, Jhingook Kim, Young Tae Kim, Laura Kingsbury, Haruhiko Kondo, Mark Krasnik, Kaoru Kubota, Antoon Lerut, Gustavo Lyons, Mirella Marino, Edith M Marom, Jan van Meerbeeck, Alan Mitchell, Takashi Nakano, Andrew G Nicholson, Anna Nowak, Michael Peake, Thomas Rice, Kenneth Rosenzweig, Enrico Ruffini, Valerie Rusch, Nagahiro Saijo, Paul Van Schil, Jean-Paul Sculier, Lynn Shemanski, Kelly Stratton, Kenji Suzuki, Yuji Tachimori, Charles F Thomas Jr, William Travis, Ming S Tsao, Andrew Turrisi, Johan Vansteenkiste, Hirokazu Watanabe, Yi-Long Wu, Paul Baas, Jeremy Erasmus, Seiki Hasegawa, Kouki Inai, Kemp Kernstine, Hedy Kindler, Lee Krug, Kristiaan Nackaerts, Harvey Pass, David Rice, Conrad Falkson, Pier Luigi Filosso, Giuseppe Giaccone, Kazuya Kondo, Marco Lucchi, Meinoshin Okumura, Eugene Blackstone, F Abad Cavaco, E Ansótegui Barrera, J Abal Arca, I Parente Lamelas, A Arnau Obrer, R Guijarro Jorge, D Ball, G K Bascom, A I Blanco Orozco, M A González Castro, M G Blum, D Chimondeguy, V Cvijanovic, S Defranchi, B de Olaiz Navarro, I Escobar Campuzano, I Macía Vidueira, E Fernández Araujo, F Andreo García, K M Fong, G Francisco Corral, S Cerezo González, J Freixinet Gilart, L García Arangüena, S García Barajas, P Girard, T Goksel, M T González Budiño, G González Casaurrán, J A Gullón Blanco, J Hernández Hernández, H Hernández Rodríguez, J Herrero Collantes, M Iglesias Heras, J M Izquierdo Elena, E Jakobsen, S Kostas, P León Atance, A Núñez Ares, M Liao, M Losanovscky, G Lyons, R Magaroles, L De Esteban Júlvez, M Mariñán Gorospe, B McCaughan, C Kennedy, R Melchor Íñiguez, L Miravet Sorribes, S Naranjo Gozalo, C Álvarez de Arriba, M Núñez Delgado, J Padilla Alarcón, J C Peñalver Cuesta, J S Park, H Pass, M J Pavón Fernández, M Rosenberg, E Ruffini, V Rusch, J Sánchez de Cos Escuín, A Saura Vinuesa, M Serra Mitjans, T E Strand, D Subotic, S Swisher, R Terra, C Thomas, K Tournoy, P Van Schil, M Velasquez, Y L Wu, K Yokoi
Abstract
Introduction: The aim of this study is to analyze all metastatic (M) categories of the current tumor, node, and metastasis (TNM) classification of lung cancer with the objective of providing suggestions for modifications of the M component in the next edition of the TNM classification for lung cancer.
Methods: The new International Association for the Study of Lung Cancer lung cancer database was created from 94,708 patients diagnosed as having lung cancer between 1999 and 2010. Including further patients submitted through the electronic data capture system to Cancer Research and Biostatistics until 2012, all together 1059 non-small-cell lung cancer cases were available for a detailed analysis of the clinical M categories. Overall survival was calculated using the Kaplan-Meier method, and prognosis was assessed using a Cox proportional hazards regression analysis.
Results: No significant differences were found among the M1a (metastases within the chest cavity) descriptors. However, when M1b (distant metastases outside the chest cavity) were assessed according to the number of metastases, tumors with a single metastasis in a single organ had significantly better prognosis than those with multiple metastases in one or several organs.
Conclusions: In this revision of the TNM classification, cases with pleural/pericardial effusions, contralateral/bilateral lung nodules, contralateral/bilateral pleural nodules, or a combination of multiple of these parameters should continue to be grouped as M1a category. Single metastatic lesions in a single distant organ should be newly designated to the M1b category. Multiple lesions in a single organ or multiple lesions in multiple organs should be reclassified as M1c category. This new division can serve as a first step into providing rational definitions for an oligometastatic disease stage in non-small-cell lung cancer in the future.
Source: PubMed