The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer

Abstract

The Tumour, Node, Metastasis (TNM) system for classifying lung cancer is the cornerstone of modern lung cancer treatment and underpins comparative research; yet is continuously evolving through updated revisions. The recently published Union for International Cancer Control 7th Edition TNM Classification for lung cancer addresses many of its predecessor's shortcomings and has been subject to rigorous evidence-based methodology. It is based on a retrospective analysis of over 80 000 lung cancer patients treated between 1990 and 2000 carried out by the International Association for the Study of Lung Cancer. The dataset was truly international and included patients treated by all modalities. Extensive internal and external validation of the findings has ensured that the recommendations are robust and generalizable. For the first time, a single classification system has been shown to be applicable not only to non-small cell lung cancer, but also to be of prognostic significance in small cell lung cancer and bronchopulmonary carcinoid tumours.We review the history of the Union for International Cancer Control TNM staging system, the changes in the most recent 7th edition and the strength of the scientific basis motivating these changes. Limitations of the current staging edition are explored, post-publication independent validation studies are reviewed, and the future of TNM staging for lung cancer is discussed.

Inhibition of non-small cell lung cancer (NSCLC) growth by a novel small molecular inhibitor of EGFR

“…Approximately 80% of all lung cancer cases are categorized as non-small cell lung cancer (NSCLC), which is typically diagnosed at advanced stages [2, 3]. With regards to lung cancer mortality, 80%–90% of these cases are associated with metastasis and one of the most common cases is bone metastasis [4, 5]. Among lung cancer bone metastasis, the most frequent target organ is the vertebral column, which causes even more severe consequences to patients’ recovery rate and life quality [6, 7].…”

Germline polymorphisms and survival of lung adenocarcinoma patients: A genome‐wide study in two European patient series

“…The TNM staging system is commonly used in clinical practice for predicting prognosis and treatment requirements of patients with lung cancer . However, the outcome of patients who apparently have the same stage of disease can vary .…”

Staging with PET-CT in Patients with Locally Advanced Non Small Cell Lung Cancer is Superior to Conventional Staging Methods in Terms of Survival

“…At the time of diagnosis approximately 43% of patients who are suffering from NSCLC are locally advanced (Tachfouti et al, 2012). According to the 7 th edition of Tumor, Node, Metastasis (TNM) in lung cancer, locally advanced NSCLC consists of stage III A (T1a,b T2 a,b N2M0/T3N1,2M0/T4N0,1M0) and IIIB (T4N2M0/T any N3M0) disease (Marshall et al, 2012). Currently, surgical resection remains the primary strategy for the treatment of patients with NSCLC at stage I, II, and IIIA (Wang et al, 2012).…”