Metastasis Classification For Lung Cancer Research Articles

Evaluation of solid portions in non-small cell lung cancer-the solid part is not always measurable for clinical T factor.

Solid component size on thin-section computed tomography is used for T-staging according to the eighth edition of the Tumor Node Metastasis classification of lung cancer. However, the feasibility of using the solid component to measure clinical T-factor remains controversial. We evaluated the feasibility of measuring the solid component in 859 tumours, which were suspected cases of primary lung cancers, requiring surgical resection regardless of the procedure or clinical stage. After excluding 126 pure ground-glass opacity tumours and 450 solid tumours, 283 part-solid tumours were analysed to determine the frequency of cases where the measurement of the solid portion was difficult along with the associated cause. Pathological invasiveness was also evaluated. The solid portion of 10 lesions in 283 part-solid nodules was difficult to measure due to an underlying lung disease (emphysema and pneumonitis). The solid portion of 62 lesions (21.9%) without emphysema and pneumonitis was difficult to measure due to imaging features of the tumours. Among the 62 patients, five had no malignancy and one with a tumour size of 33mm had nodal metastasis. There were 56 lesions with a tumour size of ≤30mm, wherein nodal metastases, vascular and/or lymphatic invasions were not observed. For one-fifth of the part-solid tumours, measurement of the solid component was difficult. Moreover, these lesions had low invasiveness, especially in T1. The measurement of the solid portion and the classification of T1 in 1-cm increments may be complex.

Efficacy of measuring the invasive diameter of lung adenocarcinoma using mediastinal window settings: A retrospective study.

The recently published 8th edition of the tumor node and metastasis Classification of Lung Cancer proposes using the maximum dimension of the solid component of a ground glass nodule (GGN) for the T categorization. However, few studies have investigated the collection of this information when using mediastinal window settings. In this study, we evaluated tumor measurement data obtained from computed tomography (CT) scans when using mediastinal window settings.This study included 202 selected patients with persistent, partly solid GGNs detected on thin-slice CT after surgical treatment between 2004 and 2013. We compared the differences in tumor diameters measured by 2 different radiologists using a repeated-measures analysis of variance. We divided the patients into 2 groups based on the clinical T stage (T1a+T1b vs T1c) and estimated the probability of overall survival (OS) and disease-free survival (DFS) using Kaplan–Meier curves.The study included 94 male and 108 female patients. The inter-reviewer differences between tumor diameters were significantly smaller when the consolidation to maximum tumor diameter ratio was ≤0.5. The 2 clinical groups classified by clinical T stage differed significantly with respect to DFS when using the mediastinal window settings. However, no significant differences in OS or DFS were observed when using the lung window setting.Our study yielded 2 major findings. First, the diameters of GGNs could be measured more accurately using the mediastinal window setting. Second, measurements obtained using the mediastinal window setting more clearly depicted the effect of clinical T stage on DFS.

Towards the 9th Edition of the Tumour, Node and Metastasis Classification of Lung Cancer. A Historical Appraisal and Future Perspectives.

Since 1966 the classification of anatomic extent of lung cancer, based on the primary tumour (T), the loco-regional lymph nodes (N) and the metastases (M) has been used in the management of lung cancer patients. Developed by Pierre Denoix, it was adopted by the Union for International Cancer Control and the American Joint Committee on Cancer. Clifton Mountain revised the second through the sixth editions based on a North American database of more than 5000 patients. For the seventh and the eighth editions, the International Association for the Study of Lung Cancer (IASLC) collected international databases of around 100,000 patients worldwide that allowed the introduction of innovations in both editions, namely the subdivision of the T and M categories based on tumour size and on the location and number of metastases, respectively. The revisions also showed the prognostic relevance of the quantification of nodal disease, and proposed recommendations on how to measure tumour size for solid lung cancers, part-solid adenocarcinomas, and for lung cancers removed after induction therapy. Despite the innovations, prognosis based on the anatomic extent is limited, because prognosis depends on factors related to the tumour, the patient and the environment. For the 9th edition, these factors, especially genetic biomarkers, will be combined in prognostic groups to refine prognosis at clinical and pathologic staging. To achieve this challenging objective, international cooperation is essential, and the IASLC Staging and Prognostic Factors Committee counts on it for the development of the 9th edition due to be published in 2024.

Prognostic Factors in Stage IIB Non-Small Cell Lung Cancer according to the 8th Edition of TNM Staging System.

BackgroundThe purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease.MethodsPatients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients.ResultsOf 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC.ConclusionThe stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.

Towards the 9th Edition of the Tumour, Node and Metastasis Classification of Lung Cancer. A Historical Appraisal and Future Perspectives

Since 1966 the classification of anatomic extent of lung cancer, based on the primary tumour (T), the loco-regional lymph nodes (N) and the metastases (M) has been used in the management of lung cancer patients. Developed by Pierre Denoix, it was adopted by the Union for International Cancer Control and the American Joint Committee on Cancer. Clifton Mountain revised the second through the sixth editions based on a North American database of more than 5000 patients. For the seventh and the eighth editions, the International Association for the Study of Lung Cancer (IASLC) collected international databases of around 100,000 patients worldwide that allowed the introduction of innovations in both editions, namely the subdivision of the T and M categories based on tumour size and on the location and number of metastases, respectively. The revisions also showed the prognostic relevance of the quantification of nodal disease, and proposed recommendations on how to measure tumour size for solid lung cancers, part-solid adenocarcinomas, and for lung cancers removed after induction therapy. Despite the innovations, prognosis based on the anatomic extent is limited, because prognosis depends on factors related to the tumour, the patient and the environment. For the 9th edition, these factors, especially genetic biomarkers, will be combined in prognostic groups to refine prognosis at clinical and pathologic staging. To achieve this challenging objective, international cooperation is essential, and the IASLC Staging and Prognostic Factors Committee counts on it for the development of the 9th edition due to be published in 2024.

Lung cancer staging: a concise update.

Diagnosis and clinical staging of lung cancer are fundamental to planning therapy. The techniques for clinical staging, i.e anatomic and metabolic imaging, endoscopies and minimally invasive surgical procedures, should be performed sequentially and with an increasing degree of invasiveness. Intraoperative staging, assessing the magnitude of the primary tumour, the involved structures, and the loco-regional lymphatic spread by means of systematic nodal dissection, is essential in order to achieve a complete resection. In resected tumours, pathological staging, with the systematic study of the resected specimens, is the strongest prognostic indicator and is essential to make further decisions on therapy. In the present decade, the guidelines on lung cancer staging of the American College of Chest Physicians and the European Society of Thoracic Surgeons are based on the best available evidence and are widely followed. Recent advances in the classification of the adenocarcinoma of the lung, with the definition of adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma, and the publication of the eighth edition of the tumour, node and metastasis classification of lung cancer, have to be integrated into the staging process. The present review complements the latest guidelines on lung cancer staging by providing an update of all these issues.

ED14.04 Is There a Role for Surgery in SCLC?

ED14.04 Is There a Role for Surgery in SCLC?

Surgery in oligometastatic NSCLC patients in the targeted therapy era.

More than 50% of NSCLC patients present with metastatic disease at first diagnosis, with a median survival of 8-11 months. However, selected patients with oligometastatic disease who receive appropriate local therapy for both the primary lesion and metastases enjoy long-term survival or are even cured. The new (eighth) edition of the tumor, node and metastasis classification of lung cancer suggests that patients with a single metastatic lesion in one distant organ should be placed into a new category, M1b, which will certainly lead to more applications of local therapy in such subpopulations. Moreover, as the applications of targeted therapy increase, surgery will play an evermore critical role in eliminating drug-resistant cancer clones of patients who exhibit mixed responses to tyrosine kinase inhibitors. The lung, brain and adrenal gland are the most common oligometastatic organs, and are reviewed separately.

Tumor, node and metastasis classification of lung cancer – M1a versus M1b – Analysis of M descriptors and other prognostic factors

IntroductionThe current edition of the tumor, node and metastasis (TNM) classification of lung cancer (LC) divides the presence of metastasis (M1) into two categories: M1a and M1b, depending on its anatomical location. To assess this new classification, the survival and the M descriptors of LC patients with metastatic disease registered by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery II (GCCB-S-II), were analyzed. MethodsNon-small cell lung cancer (NSCLC) patients, with M1a or M1b disease, included in the GCCB-S-II, from April 2009 to December 2010, staged in accordance with the prospective staging project protocol of the International Association for the Study of Lung Cancer (IASLC), and with complete TNM staging and follow-up data, were studied. The overall survival associated with each M1 category and each M descriptor, besides other prognostic factors (sex, age, performance status [PS] and others) were analyzed by univariate and multivariate models. Results640 NSCLC patients (195 M1a and 445 M1b) were included. M1b tumors had significantly worse survival than M1a tumors (p<0.001). The prognostic value of M1 category was independent from other prognostic variables such as PS, weight loss, and others. The number of metastatic sites (isolated versus multiple) and the number of lesions (single versus multiple) in patients with isolated metastasis showed prognostic value, especially in those with brain metastasis. ConclusionThe current division of the M1 category into two subsets (M1a and M1b) is warranted by their prognostic significance. The number of metastatic sites and the number of lesions in patients with isolated metastasis should be taken into account, because they also have prognostic relevance.

Visceral Pleural Invasion Classification in Non–Small-Cell Lung Cancer in the 7th Edition of the Tumor, Node, Metastasis Classification for Lung Cancer: Validation Analysis Based on a Large-Scale Nationwide Database

In the 7th tumor, node, metastasis (TNM) classification, visceral pleural invasion (VPI) is defined as invasion beyond the elastic layer, including invasion to the visceral pleural surface, and T1 tumors with VPI are upgraded to T2a. To validate this, we analyzed the survival of non-small-cell lung cancer patients from a nationwide database and evaluated the prognostic impact of VPI. The clinicopathological characteristics and prognosis of 4995 patients who were included in the registry study of the Japanese Joint Committee of Lung Cancer Registry were retrospectively analyzed with a special interest in the prognostic impact of VPI. These patients underwent surgery in 2004 and were pathologically staged as T1a-3N0. VPI was defined as including PL1 and PL2 according to the 7th TNM Classification, but the Japanese Joint Committee of Lung Cancer Registry did not collect data regarding staining or how extensively VPI was evaluated in each participating institution. The survival differences were statistically significant between PL0 and PL1, PL1 and PL2, as well as PL2 and T3. There were no significant survival differences between T1a with VPI and T1b without VPI, or between T1a with VPI and T2a without VPI. There were no significant survival differences between T1b with VPI and T2a without VPI, or between T1b with VPI and T2b without VPI. There were no significant survival differences between T2a with VPI and T2b without VPI, or between T2b with VPI and T2b without VPI. T3 showed significantly worse prognosis than T2a with VPI and T2b with VPI. In addition to the current TNM classification recommendations, in which T1 tumors with VPI are upgraded to T2a, T2a tumors with VPI should be classified as T2b.

Lung cancer staging: pathology issues

The previous, 6th, American Joint Committee on Cancer and International Union Against Cancer Staging Manual classification of lung cancer was largely unchanged from 5th edition. However, the most recent, 7th, edition has significantly updated the tumor, node, metastasis classification of lung cancer with regards to the inclusion of additional size criteria for T stages and revision of the staging for multiple tumor nodules, and represents the most dramatic change in 30 years. The recommendations for this most recent edition of tumor, node, metastasis classification are derived from a systematic retrospective review of data from a multi-international/institutional database of lung cancers and also incorporate expert opinion, to revise and clarify various staging factors. This review will primarily focus on the pathologically relevant aspects of 7th edition of American Joint Committee on Cancer/International Union Against Cancer classification of lung cancer as well as briefly reviewing the new staging guidelines.

Time Trends of Overall Survival and Survival after Recurrence in Completely Resected Stage I Non-small Cell Lung Cancer

The seventh edition of the tumor, node, metastasis classification for lung cancer has been published in 2009. The aim of this study is to evaluate time trends of surgical outcomes and clinicopathologic factors in patients with pathological stage I non-small cell lung cancer according to the seventh edition of the tumor, node, metastasis classification. We retrospectively reviewed the clinicopathologic characteristics of 1249 patients with pathological stage I non-small cell lung cancer from Taipei Veterans General Hospital between January 1980 and December 2006, during the three periods of 1980-1990, 1991-2000, and 2001-2006. The overall survival, disease-specific survival, and postrecurrence survival were analyzed. The 5-year overall survival rates during the three periods improved significantly: 53.7, 59.9, and 69.3%, respectively (p < 0.001). The 2-year postrecurrence survival rates during the three periods improved significantly: 10.6, 25.4, and 43.2%, respectively (p < 0.001). The percentage of female patients increased during each period: 15.4, 24.9, and 32.0%, respectively (p < 0.001). The percentage of adenocarcinoma also increased during each period: 51.2, 62.2, and 74.9%, respectively (p < 0.001). Tumor size during each period was 3.2, 3.2, and 2.8 cm, tending to be smaller when diagnosed in the last period (p < 0.001). The overall survival in patients with squamous cell carcinoma and those undergoing pneumonectomy or bilobectomy did not improve over time. Stage migration, improved postrecurrence survival, increased frequencies of female gender and adenocarcinoma, and decreased tumor size lead to improved overall survival over the past three decades.

The Role of Surgery in the Treatment of Limited Disease Small Cell Lung Cancer: Time to Reevaluate

Chemo-radiation is considered the standard procedure for the management of limited disease small-cell lung cancer (SCLC). Controversy remains as to when surgery should be considered. We sought to determine the survival after complete resection of SCLC and the prognostic impact of clinical and pathologic stage. A retrospective review was undertaken of patients who underwent surgery between 1980 and 2006. Patients were staged according to the 6th edition of the Tumor, Node, Metastasis classification of lung cancer, actuarial survival estimated with Kaplan Meier methods and comparisons were undertaken using Cox regression. We identified 59 patients who underwent complete resection with nodal dissection for SCLC. The mean age (SD) was 62 (11) years and 41 (69%) were men. Clinical staging information was available in 53, listed by stage with IA (n = 9), IB (n = 21), IIA (n = 0), IIB (n = 13), IIIA (n = 9), IIIB (n = 1). The median time to follow-up (1st to 3rd quartile) was 2.8 (0.79-8.65) years with an overall survival (95% confidence interval) at 1 and 5 years of 76% (65, 88), 52% (40, 68). There were no clear differences in the survival of patients in clinical T categories (p = 0.366) with good overall results in patients across the spectrum of nodal disease from N0 to N2 (p = 0.498). This study shows excellent survival for stage I to III patients who underwent lung resection with nodal dissection for SCLC and supports the need to reevaluate surgery as primary treatment and use of clinical Tumor, Node, Metastasis criteria in the selection of patients with very limited disease for surgery.

The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals Regarding the Clinical Staging of Small Cell Lung Cancer in the Forthcoming (Seventh) Edition of the Tumor, Node, Metastasis Classification for Lung Cancer

Small cell lung cancer (SCLC) is usually classified using the limited and extensive definition. The tumor, node, metastasis (TNM) classification should also be applicable to SCLC, but it has only been reported in small surgical series. The current analysis looks to the impact of the TNM system on the clinical staging of SCLC and of the new International Association for the study of Lung Cancer (IASLC) proposals. Using the IASLC database, survival analyses were performed for clinically staged patients. Prognostic groups were compared, and the new IASLC TNM proposals were applied to this population and to the Surveillance, Epidemiology, and End Results (SEER) database. The IASLC database contained 12,620 eligible cases of small cell histology. TNM staging was available for 8088 patients. Survival was directly correlated to both T and N category. Differences were more pronounced in patients without mediastinal or supraclavicular nodal involvement. Stage grouping using the sixth edition of TNM also differentiates survival except between IA and IB. Patients with pleural effusion regardless of the cytology have an intermediate prognosis between limited and extensive disease. The IASLC proposals for the seventh edition of the TNM classification also apply to this series of SCLC and to the SEER database. TNM staging is recommended for SCLC, and stratification by stage I-III should be incorporated in clinical trials of early-stage disease. Further studies are needed to clarify the impact of pleural effusion and the extent of N3 disease.