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Comments on the eighth edition of the TNM classification for lung cancer. Radical changes and limitations: Does size matter?

  • Thoracic Oncology
  • Published:
Hellenic Journal of Surgery

Abstract

Aim-Background

Cancer is a major public health problem worldwide and the second leading cause of death in the United States of America (USA), following heart disease. Male lung cancer death rates are decreasing in the western world and increasing in China and several other countries in Asia and Africa. Female lung cancer death rates are increasing worldwide, with the exception of the USA, Canada and Australia. Differences in lung cancer incidence patterns between men and women reflect historical differences in tobacco use. Staging of cancer at the time of diagnosis is the most important predictor of survival, and treatment options should be based on the stage. The aim of this overview is to discuss the changes in the 8th Edition of the TNM (Tumor, Nodes, Metastasis) Classification of lung cancer and its impact on predicting patient prognosis. Potential limitations of the classification system and future directions are discussed.

Methods

A systematic literature search was performed to identify relevant reports. Studies and articles were identified using several online searches of the U.S. National Library of Medicine via www.pubmed.com. The article is based on the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee report. An international lung cancer database was developed from 35 sources in 16 countries around the globe, with staging and outcome data on 94,708 cases of lung cancer.

Result

This new edition of lung cancer TNM staging placed additional emphasis on tumor size, and size cut-off points have been added, which will now be a descriptor in all TNM categories. For the first time a new term was introduced, defined as minimally invasive adenocarcinoma. The additional cut-off point changes will definitely alter treatment recommendations in the future. The node classification remained unchanged in the new edition. Regarding metastasis, M1a refers to cases with intrathoracic metastases, M1b cases with a single metastasis outside the thoracic cavity. The situation involving multiple metastatic deposits, usually in more than one organ, is now classified as M1c.

Conclusions

The new staging of lung cancer is based on analysis of survival in large databases, based on tumor size and disease proliferation, and is therefore expected to assess the prognosis of the individual patient more accurately. Based on the current edition of the TNM staging system many patients will be given a different staging category,. It is evident that improved survival may reflect the expected improvements in diagnosis and treatment, the net effect being a stage-for-stage survival increase at all stages. This 8th edition of the TNM classification for lung cancer has placed additional emphasis on tumor size.

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Authors and Affiliations

  1. Thorax Center, Corfu, Greece

    S. Nikolouzos

  2. Corfu, Greece

    G. Zacharia

  3. Department of Thoracic Surgery, Metaxa Memorial Cancer Hospital, Piraeus, Greece

    N. Baltayiannis, D. Anagnostopoulos, N. Bolanos & A. P. Chatzimichalis

  4. Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece

    M. Kanakis & A. Lioulias

  5. Oncology Unit, 3rd Department of Medicine, School of Medicine, National and Kapodistrian University of Athens, Sotiria Hospital for Chest Diseases, Athens, Greece

    A. Charpidou & K. N. Syrigos

  6. Department of Surgery, Ioannina University Hospital, Ioannina, Greece

    M. Mitsis

  7. Department of Cardiothoracic Surgery, Ioannina University Hospital, Ioannina, Greece

    E. Apostolakis

  8. Thorax Center, 2A, Ioannis Romanos St., 49132, Corfu, Greece

    S. Nikolouzos

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  1. S. Nikolouzos
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  2. G. Zacharia
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  3. N. Baltayiannis
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  4. D. Anagnostopoulos
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  5. N. Bolanos
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  6. M. Kanakis
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  7. A. Charpidou
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  8. A. P. Chatzimichalis
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  9. A. Lioulias
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  12. E. Apostolakis
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Correspondence to S. Nikolouzos.

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Nikolouzos, S., Zacharia, G., Baltayiannis, N. et al. Comments on the eighth edition of the TNM classification for lung cancer. Radical changes and limitations: Does size matter?. Hellenic J Surg 89, 141–148 (2017). https://doi.org/10.1007/s13126-017-0401-7

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  • DOI: https://doi.org/10.1007/s13126-017-0401-7

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