Tumor, node, metastasis (TNM) staging system for non-small cell lung cancer
- Karl W Thomas, MD
Karl W Thomas, MD
- Professor of Medicine - Pulmonary, Critical Care, Allergy and Immunology
- Wake Forest School of Medicine
- Michael K Gould, MD, MS
Michael K Gould, MD, MS
- Senior Research Scientist
- Director for Health Services Research
- Department of Research and Evaluation
- Kaiser Permanente Southern California
- Section Editors
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
The Tumor, Node, Metastasis (TNM) staging system for non-small cell lung cancer (NSCLC) is an internationally accepted system used to characterize the extent of disease. The TNM system combines features of the tumor into disease stage groups that correlate with survival and are linked to recommendations for treatment. Despite the evolving staging system, the links between stage and treatment have become weaker, given that older studies of stage-specific treatments were performed at a time that predated the staging techniques and treatments of modern clinical practice.
The purpose of TNM staging is to provide a description of the anatomic extent of cancer that can be easily communicated to others, assist in treatment decisions, and serve as an indicator of prognosis. It allows a way to compare cases, particularly in regards to the outcomes associated with different therapeutic options. In clinical practice, TNM stage is combined with the unique clinical characteristics of the patient and, in some cases, the molecular features of the tumor itself to guide prognostic assessment and treatment selections.
The eighth edition of the TNM staging system and the evidence supporting it are described in this topic (table 1 and table 2) [1,2]. The eighth edition will replace earlier editions of the TNM staging system beginning January 1, 2018. All newly diagnosed cases through December 31, 2017 should be staged with the seventh edition (table 3). However, outside of the United States, the UICC has implemented the eighth edition changes as of January 1, 2017. Other relevant topics include:
- Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11:39.
- AJCC (American Joint Committee on Cancer) Cancer Staging Manual, 8th edition, Amin MB, Edge SB, Greene FL et al. (Eds), Springer, Chicago 2017.
- Detterbeck FC, Chansky K, Groome P, et al. The IASLC Lung Cancer Staging Project: Methodology and Validation Used in the Development of Proposals for Revision of the Stage Classification of NSCLC in the Forthcoming (Eighth) Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2016; 11:1433.
- Detterbeck FC, Boffa DJ, Kim AW, Tanoue LT. The Eighth Edition Lung Cancer Stage Classification. Chest 2017; 151:193.
- Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2:706.
- Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2015; 10:990.
- Asamura H, Chansky K, Crowley J, et al. The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming 8th Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2015; 10:1675.
- Rusch VW, Asamura H, Watanabe H, et al. The IASLC lung cancer staging project: a proposal for a new international lymph node map in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol 2009; 4:568.
- Eberhardt WE, Mitchell A, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol 2015; 10:1515.
- RATIONALE FOR DISTINCTION BETWEEN NSCLC AND SCLC
- EIGHTH EDITION OF THE TNM SYSTEM
- Differences between eighth and seventh editions
- - Primary tumor
- - Regional lymph nodes
- - Metastasis
- - Changes to the stage groupings
- Prognosis by stage
- SEVENTH EDITION OF THE TNM SYSTEM
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS