Staging of lung cancer: The new international system

Abstract

Abstract New recommendations for staging lung cancer using the TNM system for description of the primary tumor (T), the regional lymph nodes (N), and distant metastases (M) have been adopted by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer. Revisions in TNM definitions and stage grouping rules were made in response to the needs of investigators throughout the world for staging that is consistent in meaning among all specialities and among all countries. The new international system has five stage groups, O, I, II, IIIa, IIIb and IV, that provide for classification of six levels of disease extent. A number of elements used in prior staging recommendations have been retained; however, new descriptors for the degree of progression in tumors with extrapulmonary extension and for the levels of regional lymph node metastasis have been structured. The new system allows for specific definition of ‘limited’ and ‘extensive’ disease categories that can be reproduced and compared. It meets the goal of providing an internationally acceptable staging system for lung cancer that is useful for estimating prognosis, reporting end results and selection of appropriate treatment. A new system for staging lung cancer has been accepted by international groups concerned with uniform classification of the extent of disease in cancer patients1. These new recommendations meet the need of treatment specialists for staging that is responsive to the requirements of contemporary therapeutic planning. Differences in the two most widely used systems, those of the International Union Against Cancer (UICC)2–3 and the American Joint Committee on Cancer (AJCC)4–6 have been resolved and we now have recommendations for TNM classification and staging of lung cancer that are acceptable to the international scientific community. American Joint Committee on Cancer, Hawn Foundation of Texas, Herman Neel Hipp Fund for Research in Thoracic Surgery, Kelsey-Seybold Foundation grant 996, National Cancer Institute Division of Cancer Treatment (contract CA34503 Reference Center for Anatomic and Pathologic Classification of Lung Cancer of the Lung Cancer Study Group), Private Donors Fund for Research in Thoracic Surgery (Department of Thoracic Surgery, University of Texas System Cancer Center, M.D. Anderson Hospital).