Application of the new 8th TNM staging system for non-small cell lung cancer: treated with curative concurrent chemoradiotherapy

Choi, Hyejung; Jeong, Bae Kwon; Jeong, Hojin; Lee, Yun Hee; Ha, In Bong; Song, Jin Ho; Kang, Ki Mun

doi:10.1186/s13014-017-0848-2

Cited by 27 publications

(18 citation statements)

References 25 publications

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“…Tumor, lymph node and metastasis (TNM) staging are often used in treatment decisions and prognosis prediction of lung cancer patients 47 . For NSCLC, stages I-II are considered early stages and are normally treated with surgery, while stages III-IV are advanced stages and are normally treated with concurrent chemoradiotherapy 48 . Our results showed a correlation between TP53 and RB1 mutations and tumor stages III-IV.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive genomic profile of Chinese lung cancer patients and mutation characteristics of individuals resistant to icotinib/gefitinib

Shang

Liu

et al. 2020

Sci Rep

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Lung cancer is the leading causes of cancer-related death worldwide. Precise treatment based on next-generation sequencing technology has shown advantages in the diagnosis and treatment of lung cancer. This cohort study included 371 lung cancer patients. The lung cancer subtype was related to the smoking status and sex of the patients. The most common mutated genes were TP53 (62%), EGFR (55%), and KRAS (11%). The mutation frequencies of EGFR, TP53, PIK3CA, NFE2L2, KMT2D, FGFR1, CCND1, and CDKN2A were significantly different between lung adenocarcinoma and lung squamous cell carcinoma. We identified the age-associated mutations in ALK, ERBB2, KMT2D, RBM10, NRAS, NF1, PIK3CA, MET, PBRM1, LRP2, and CDKN2B; smoking-associated mutations in CDKN2A, FAT1, FGFR1, NFE2L2, CCNE1, CCND1, SMARCA4, KEAP1, KMT2C, and STK11; tumor stage-associated mutations in ARFRP1, AURKA, and CBFB; and sex-associated mutations in EGFR. Tumor mutational burden (TMB) is associated with tumor subtype, age, sex, and smoking status. TMB-associated mutations included CDKN2A, LRP1B, LRP2, TP53, and EGFR. EGFR amplification was commonly detected in patients with acquired lcotinib/gefitinib resistance. DNMT3A and NOTCH4 mutations may be associated with the benefit of icotinib/gefitinib treatment.

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Section: Discussionmentioning

confidence: 99%

Comprehensive genomic profile of Chinese lung cancer patients and mutation characteristics of individuals resistant to icotinib/gefitinib

Shang

Liu

et al. 2020

Sci Rep

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“…As with previous editions, most of the patients were treated with surgery, with little data on patients that were treated by radiotherapy and chemotherapy alone (n=157, 4.7%, decreased from previous 12%). As such, the generalisability of the new staging across non-surgical treatment modalities, and in turn, the prognostic impact of the TNM descriptors, may differ depending on the treatment applied (21). More studies are already on the way for external validation of the 8 th edition TNM.…”

Section: Limitations Of the New Classificationmentioning

confidence: 99%

The 8th lung cancer TNM classification and clinical staging system: review of the changes and clinical implications

Lim¹,

Ridge²,

Nicholson³

et al. 2018

Quant. Imaging Med. Surg.

213

145

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Lung cancer is the leading cause of cancer death in both men and women. Clinical staging plays a crucial role in predicting survivor as well as influencing management option in lung cancer patients. Guidelines are constantly being reviewed as more data becomes available to provide the most accurate prognostic markers, hence aiding in the clinical detection and staging of lung cancer. Since its introduction in the 1970s, the TNM staging has undergone significant revisions with the latest, 8 edition, being effective internationally from 2018. This edition re-categorizes the tumour size and other non-quantitative tumour descriptors (T), and further subclassifies extra-thoracic metastases (M). The clinical nodal (N) classifier is unchanged as the earlier version correlates well with prognosis. The downstream effects on staging to accommodate for the new T and M classifications are highlighted. The survival is inversely proportional to every centimeter increase in tumour size up till 7 cm, where the same prognosis as a T4 disease is reached. Hence, some of the T-classifiers based on size of the tumour is upstaged to reflect that. Invasion of the diaphragm is considered T4 instead of T3. On the other hand, involvement of the main bronchus regardless of tumour distance to carina as well as atelectasis is down-staged from a T3 to a T2 disease. Since the 7 edition, new entities of lung tumour known as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have been introduced. The T-defining features are also described in this manuscript. Extrathoracic metastases that were classified as M1b in the 7 edition is further subcategorized into M1b and M1c in the 8 edition, to better define oligometastasis which has a better prognosis, and may benefit from more aggressive local therapy. This overview aims to provide radiologists with a description of the changes in the latest edition including staging of subsolid and multiple nodules, outline potential limitations of this 8 edition, as well as discussion on the implications on treatment.

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“…The TNM staging system, which classifies cancer according to the size and extension of the primary tumor, its lymphatic involvement, and the presence of metastases, is frequently used in clinical practice to predict prognosis (20). Its reliability has been fully established through the IASLC (International Association for the Study of Lung Cancer) study (21).…”

Section: Discussionmentioning

confidence: 99%

Development of a Survival Prognostic Model for Non-small Cell Lung Cancer

Zhang

et al. 2020

Front. Oncol.

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Lung cancer is a leading cause of cancer-related death, and >80% of lung cancer diagnoses are non-small-cell lung cancer (NSCLC). However, when using current staging and prognostic indices, the prognosis can vary significantly. In the present study, we calculated a prognostic index for predicting overall survival (OS) in NSCLC patients. The data of 545 NSCLC patients were retrospectively reviewed. Univariate and multivariate Cox proportional hazards regression analyses were performed to evaluate the prognostic value of clinicopathological factors. Age (hazard ratio [HR] = 1.25, 95% confidence interval [CI] = 1.02-1.54), TNM stage (III, HR = 1.64, 95% CI = 1.08-2.48; IV, HR = 2.33, 95% CI = 1.48-3.69), lung lobectomy (HR = 1.96, 95% CI = 1.45-2.66), chemotherapy (HR = 1.42, 95% CI = 1.15-1.74), and pretreatment hemoglobin level (HR = 1.61, 95% CI = 1.28-2.02) were independent prognosticators. A prognostic index for NSCLC (PInscl, 0-6 points) was calculated based on age (≥65 years, 1 point), tumor-node-metastasis (TNM) stage (III, 1 point; IV, 2 points), lung lobectomy (no, 1 point), chemotherapy (no, 1 point), and pretreatment hemoglobin level (low, 1 point). In comparison with the "PInscl = 0" subgroup (survival time = 2.71 ± 1.86 years), the "PInscl = 2" subgroup (survival time = 1.86 ± 1.24 years), "PInscl = 3" subgroup (survival time = 1.45 ± 1.07 years), "PInscl = 4" subgroup (survival time = 1.17 ± 1.06 years), "PInscl = 5" subgroup (survival time = 0.81 ± 0.78 years), and "PInscl = 6" subgroup (survival time = 0.65 ± 0.56 years) exhibited significantly shorter survival times. Kaplan-Meier survival analysis showed that patients with higher PInscl scores had poorer OS than those with lower scores (log-rank test: χ 2 = 155.82, P < 0.0001). The area under the curve of PInscl for predicting the 1-year OS was 0.73 (95 % CI = 0.69-0.77, P < 0.001), and the PInscl had a better diagnostic performance than the Karnofsky performance status or TNM stage (P < 0.01). In conclusion, the PInscl, which is calculated from age, TNM stage, lung lobectomy, chemotherapy, and pretreatment hemoglobin level, significantly predicted OS in NSCLC patients.

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Application of the new 8th TNM staging system for non-small cell lung cancer: treated with curative concurrent chemoradiotherapy

Cited by 27 publications

References 25 publications

Comprehensive genomic profile of Chinese lung cancer patients and mutation characteristics of individuals resistant to icotinib/gefitinib

Comprehensive genomic profile of Chinese lung cancer patients and mutation characteristics of individuals resistant to icotinib/gefitinib

The 8th lung cancer TNM classification and clinical staging system: review of the changes and clinical implications

Development of a Survival Prognostic Model for Non-small Cell Lung Cancer

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