Advanced Treatment and Prognosis Data Available for TNM Classification of Lung Cancer

IASLC highlighted new data and findings for 8th edition of staging manual at 16th WCLC

The publication of the Eighth Edition of the Tumor, Node and Metastasis (TNM) Classification of Lung Cancer will provide physicians around the world access to new data to more precisely stage and treat patients with lung cancer. That data, collected by the International Association for the Study of Lung Cancer (IASLC) Staging and Prognostic Factors Committee and presented at the 16th World Conference on Lung Cancer (WCLC) in Denver on 8 September, 2015 will be published in 2016.

In 1998, IASLC established its Lung Cancer Staging Project, an effort to collect a significant, international database of lung cancer cases and their anatomical classifications. IASLC collected and published a large amount of data regarding the size of tumours, lymph node involvement and metastatic status which is then presented to the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) for evaluation.

Before the IASLC Staging Project, data collected for staging of lung cancer came from a smaller group of patients, almost exclusively based in the US. The new database, which will inform the Eighth Edition of the TNM Classification of Lung Cancer, consists of 94,708 patients diagnosed around the world from 1999-2010.

The objective will be to further explore and analyze the impact on prognosis of tumour size and of the different T descriptors; the prognostic significance of tumour burden in hilar and mediastinal lymph nodes; and the confirmation of the revised M1 categories (M1a and M1b) of the seventh edition of the classification along with the prognostic impact of number and anatomic location of metastases.

"The new database is much richer in details to allow refinements in the analyses of the different descriptors," said Dr Ramon Rami-Porta, Thoracic Surgery Service, Hospital Universitari Mutua Terrassa, Barcelona, Spain. "The collaboration of patients and the contributing organizations for this project are crucial to making strides in the study of lung cancer across the globe."

During the WCLC, Dr Rami-Porta discussed the work and process that goes into creating the new eighth edition and answered questions about the new classifications.

"The staging of cancer is hallowed by tradition, and for the purpose of analysis of groups of patients it is often necessary to use such a method. The UICC believes that it is important to reach agreement on the recording of accurate information on the extent of the disease for each site, because the precise clinical description of malignant neoplasms and histopathological classification may serve a number of related objectives, namely:

  • To aid the clinician in the planning of treatment
  • To give some indication of prognosis
  • To assist in evaluation of the results of treatment
  • To facilitate the exchange of information between treatment centers
  • To contribute to the continuing investigation of human cancer"

The analyses of the new database and the findings suggesting recommendations for the revision of the seventh edition of the TNM classification of lung cancer will be submitted to the Journal of Thoracic Oncology to make them available to the worldwide oncology community. The suggested recommendations and their supportive data will also be submitted to the UICC and the AJCC for their assessment and inclusion in their new staging manuals, due to be published in 2016. The new edition of the classification will then be enacted in January 2017.

The Journal of Thoracic Oncology published three articles within the past three months as part of the presentation of the new staging system.