The significance of intrapulmonary metastasis in non-small cell lung cancer: upstaging or downstaging? A re-appraisal for the next TNM staging system☆

Abstract

The presence of PM in NSCLC patients is a rare occurrence. Risk factors for the development of PM are a microscopic vascular invasion and a high nodal status. A survival advantage over other T4/M1 patients is evident from our experience, although not significant. The results of the literature which have been accumulating in the most recent years including ours bend to the conclusion that there is sufficient validated information to consider a downstaging in the presence of intrapulmonary metastases from NSCLC for the seventh edition of the TNM classification.

Non–Small Cell Lung Cancer

“…252 Intrapulmonary metastases have been downstaged in the recent TNM revised staging. 51,252,253 After surgery, concurrent chemoradiation (if tolerated) is recommended for those with positive margins, and chemotherapy is recommended for those with negative margins (see page 749).…”

Single T factors predict survival of patients with resected stage-IIB non-small-cell lung cancers

“…1. Further, it has been reported that tumors with same-lobe nodules had better prognoses than other T4 tumors that were locally advanced diseases according to the sixth edition of the TNM system [8,9]. Therefore, in the seventh TNM system, same-lobe nodules were categorized as T3, from previous T4, a locally less-invasive disease.…”

Synchronous, Metachronous or Metastases?

“…Due to the uncertainties concerning the definition of satellite tumors in most of the studies in the literature, some cases have been assessed as SLC and some as metastasis and it is seen that the patients in these studies were not homogeneous (3,6,7). Despite this, almost all studies conducted after Deslauriers et al (2) work showed that ST has a satisfactory survival time and its position in the staging system was thus changed from M1 to T3 in time (2,8).…”