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The 8 lung cancer TNM classification and clinical staging system: review of the changes and clinical implications.

作者信息

Lim Wanyin, Ridge Carole A, Nicholson Andrew G, Mirsadraee Saeed

机构信息

Department of Radiology, Royal Brompton Hospital, London, UK.

Department of Pathology, Royal Brompton Hospital, London, UK.

出版信息

Quant Imaging Med Surg. 2018 Aug;8(7):709-718. doi: 10.21037/qims.2018.08.02.


DOI:10.21037/qims.2018.08.02
PMID:30211037
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6127520/
Abstract

Lung cancer is the leading cause of cancer death in both men and women. Clinical staging plays a crucial role in predicting survivor as well as influencing management option in lung cancer patients. Guidelines are constantly being reviewed as more data becomes available to provide the most accurate prognostic markers, hence aiding in the clinical detection and staging of lung cancer. Since its introduction in the 1970s, the TNM staging has undergone significant revisions with the latest, 8 edition, being effective internationally from 2018. This edition re-categorizes the tumour size and other non-quantitative tumour descriptors (T), and further subclassifies extra-thoracic metastases (M). The clinical nodal (N) classifier is unchanged as the earlier version correlates well with prognosis. The downstream effects on staging to accommodate for the new T and M classifications are highlighted. The survival is inversely proportional to every centimeter increase in tumour size up till 7 cm, where the same prognosis as a T4 disease is reached. Hence, some of the T-classifiers based on size of the tumour is upstaged to reflect that. Invasion of the diaphragm is considered T4 instead of T3. On the other hand, involvement of the main bronchus regardless of tumour distance to carina as well as atelectasis is down-staged from a T3 to a T2 disease. Since the 7 edition, new entities of lung tumour known as adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) have been introduced. The T-defining features are also described in this manuscript. Extrathoracic metastases that were classified as M1b in the 7 edition is further subcategorized into M1b and M1c in the 8 edition, to better define oligometastasis which has a better prognosis, and may benefit from more aggressive local therapy. This overview aims to provide radiologists with a description of the changes in the latest edition including staging of subsolid and multiple nodules, outline potential limitations of this 8 edition, as well as discussion on the implications on treatment.

摘要

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本文引用的文献

[1]
Application of the new 8th TNM staging system for non-small cell lung cancer: treated with curative concurrent chemoradiotherapy.

Radiat Oncol. 2017-7-21

[2]
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CA Cancer J Clin. 2017-1-31

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J Thorac Oncol. 2016-7-21

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J Thorac Oncol. 2016-4-21

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Ann Transl Med. 2016-2

[8]
The IASLC Lung Cancer Staging Project: Background Data and Proposed Criteria to Distinguish Separate Primary Lung Cancers from Metastatic Foci in Patients with Two Lung Tumors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer.

J Thorac Oncol. 2016-3-2

[9]
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. 2016-1

[10]
Reply to "Inclusion of Lymphangitis as a Descriptor in the New TNM Staging of Lung Cancer: Filling Up the Blank Spaces".

J Thorac Oncol. 2015-12

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