Neues von der IASLC - Proposals zur 8ten Edition der TNM Klassifikation für das Lungenkarzinom. J. Pfannschmidt

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1 Neues von der IASLC - Proposals zur 8ten Edition der TNM Klassifikation für das Lungenkarzinom J. Pfannschmidt

2 Immunhistochemie durchgängig zur Klassifizierung Integration der molekularen Analyse Neuklassifizierung fu r kleine Biopsien bzw. Zytologie Neuklassifizierung der pulmonalen Adenokarzinome Neuklassifizierung der neuroendokrinen Tumoren Journal of Thoracic Oncology, 2015, 10 (9),

3 Geschichte TNM-Klassifizierung Pierre Denoix Institute Gustave-Roussy UICC (Union internationale contre le cancer), Special committee on Clinical Stage Classification, 276 Mitgliedsorganisationen in 86 Ländern 1953 Publication of the "Uniform Technique for a Clinical Classification by the TNM System 1968 Erstauflage TNM pocket book durch die UICC (TNM Prognostic Factors Project) 1987 Vereinigung der TNM Klassifikationen der UICC und AJCC (American Joint Committee for Cancer), 4te Edition te Edition te Edition 3

4 Konsertierung Proposal: IASLC Staging and Prognostic Factors Committee (W. E.E. Eberhardt/Germany) UICC + AJCC (2016) 8 th. Edition TNM (2017) 4

5 Journal of Thoracic Oncology Volume 9, Issue 11, Pages (November 2014) 5

6 EGFR-Mutation - Prävalenz 6

7 IASLC Daten 7

8 Journal of Thoracic Oncology Volume 9, Issue 11, Pages (November 2014) 8

9 T-Deskriptor Größe: cm Prognose Proposed (TNM 8th) TNM 7th TNM 8th 1 cm: T1a T1a >1-2 cm: T1a T1b >2-3 cm: T1b T1c >3-4 cm: T2a T2a >4-5 cm: T2a T2b >5-7 cm: T2b T3 >7 cm: T3 T4 Rami-Porta R, J Thoracic Oncol, 2015 International Association for the Study of Lung Cancer,

10 T-Deskriptor: weitere Neuerungen Hauptbronchus: - Abstand zur Karina < 2 cm: von T3 T2 Atelektase/Pneumonie (endobronchialer Tumor): - Totalatelektase/-Pneumonie: von T3 T2 Zwerchfellinfiltration: - von T3 T4 Infiltration der mediastinalen Pleura: - von T3 kein T Deskriptor 10

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13 T-Deskriptor: Adenokarzinom AIS Tis (AIS) multiple AIS = multiple Primaries SCC in situ Tis (SCIS) MIA T1mi Radiologie, Größenbestimmung/längste Achse/1 mm SD-CT: - Subsolide Rundherde (GGO/PSN) solider Anteil - GGO < 0.5 cm AAH (atypische adenomatöse Hyperplasie) neben anderen DD Pathologie, Größenbestimmung: - nicht schleimbildende AC: invasiver Anteil (nicht lepidisch) - IMA (Staging wie andere invasive AC) mit lepidischen Anteil Travis WD et al. JTO 2016; Vol. 11 No. 8:

14 Radiologie Travis WD et al. JTO 2016; Vol. 11 No. 8: (A) Computed tomography scan shows a part solid nodule consisting mostly of a ground glass nodule with a small solid component. (B) The longest diameter of the entire mass is 2.1 cm (ct1c). (C) The longest diameter of the solid portion is 0.9 cm (ct1a). 14

15 The mean percentages of consensual votes per pattern ranged between 59.6 and 75 %, with lepidic and solid being the pattern with the most discordant and concordant votes, respectively. The other patterns ranged in between (papillary 65.8 %; acinar 67.8 %; micropapillary 74.2 %). The extent of disagreement decreased after the educational session. 15

16 T-Deskriptor: weitere Ergänzungen Multifokale GGO (histologisch lepidisches AC): - T-Deskritor der höchsten Kategorie + Addendum m oder Anzahl Z.b. T1b(3)N0M0 oder T1b(m)N0M0 - N-Deskriptor: gemeinsam - Pneumonie-Typ AC: Single-Lobe: T nach höchster Kategorie Ipsilateral - multiple Lobe: T4 Contralateral Lobe: M1a Detterbeck FC et al. JTO

17 T Primary Tumour Tx T0 T1 T2 T3 T4 T1a(mi) T1a T1b T1c T2a T2b Primary tumour cannot be assessed No evidence of primary tumour Tumour 3 cm or less in greatest diameter surrounded by lung or visceral pleura, without evidence of main bronchus Mininally invasive adenocarcinoma Tumour 1 cm or less in greatest diameter Tumour more than 1 cm but not more than 2 cm Tumour more than 2 cm but not more than 3 cm Tumour more than 3 cm but not more than 5 cm; or tumour with any of the following features: Involves main bronchus (without involving the carina), invades visceral pleura, associated with atelectasis or obstructive pneumonitis that extends to the hilar region Tumour more than 3 cm but not more than 4 cm Tumour more than 4 cm but not more than 5 cm Tumour more than 5 cm but not more than 7 cm or one tha directly invades any of the following: chest wall, phrenic nerve, parietal pericardium, or associated separate tumour nodule(s) in the same lobe as the primary Tumours more than 7 cm or one that invades any of the following: diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body, carina; separate tumour nodule(s) in a different ipsilateral lobe to that of the primary International Association for the Study of Lung Cancer,

18 N-Deskriptor Keine Veränderung Empfehlungscharakter zur Dokumentaton: - N1 - N2 N1a: single Station N1 N1b: multiple station N1 N2a1: single station N2 ohne N1 ( skip Metastase) N2a2: single station N2 mit N1 N2b: multiple station N2 Asamura H et al. J Thorac Oncol. 2015;10:

19 N-Deskriptor N Regional Lymph Nodes Nx N0 N1 N2 N3 Regional lymph nodes cannot be assessed No regional lymph node metastasis Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s) Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene or supraclavicular lymph node(s) International Association for the Study of Lung Cancer,

20 M-Deskriptor M Distant Metastasis M0 M1 No distant metastasis Distant metastasis M1a M1b M1c Separate tumour nodule(s) in a contralateral lobe; tumour with pleaural or pericardial nodules or malignant pleural or pericardial effusion Single extrathoracic metastasis in a single organ Multiple extrathoracic metastases in one or several organs 20

21 M-Deskriptor: M1c it is recommended to prospectively register in Detail (a) the number of metastatic lesions and (b) the number of involved organs. Eberhardt WEE et al. J Thorac Oncol. 2015;10: ) 21

22 M-Deskriptor Proposed Category (8 th. Edition) Variable (7 th. Editon) M1a Stage IVa M1a M1b M1b (single organ lesion, extrathorakal) M1c Stage IVb M1b (single organ, extrathorakal/multiple lesions) M1b (multiple organs) J Thorac Oncol. 2015;10:

23 Proposed 8 th Edition J Thorac Oncol. 2015;10:

24 M-Deskriptor Martini-Melamed Kriterien in Diskussion 24

25 SCLC 25

26 STAGE T N M Occult TX N0 M0 0 Tis N0 M0 IA1 T1a(mi)/T1a N0 M0 IA2 T1b N0 M0 IA3 T1c N0 M0 IB T2a N0 M0 IIA T2b N0 M0 IIB T1a-T2b N1 M0 T3 N0 M0 IIIA T1a-T2b N2 M0 T3 N1 M0 T4 N0/N1 M0 IIIB T1a-T2b N3 M0 T3/T4 N2 M0 IIIC T3/T4 N3 M0 IVA Any T Any N M1a/M1b IVB Any T Any N M1c International Association for the Study of Lung Cancer,

27 NEW STAGE T N M Occult TX N0 M0 0 Tis N0 M0 IA1 T1a(mi)/T1a N0 M0 IA2 T1b N0 M0 IA3 T1c N0 M0 IB T2a N0 M0 IIA T2b N0 M0 IIB T1a-T2b N1 M0 T3 N0 M0 IIIA T1a-T2b N2 M0 T3 N1 M0 T4 N0/N1 M0 IIIB T1a-T2b N3 M0 T3/T4 N2 M0 IIIC T3/T4 N3 M0 IVA Any T Any N M1a/M1b IVB Any T Any N M1c International Association for the Study of Lung Cancer,

28 8th Edition of the TNM Classification for Lung Cancer N0 N1 N2 N3 M1 a M1 b M1 c T1a IA1 IIB IIIA IIIB IVA IVA IVB T1b IA2 IIB IIIA IIIB IVA IVA IVB T1c IA3 IIB IIIA IIIB IVA IVA IVB T2a IB IIB IIIA IIIB IVA IVA IVB T2b IIA IIB IIIA IIIB IVA IVA IVB T3 IIB IIIA IIIB IIIC IVA IVA IVB T4 IIIA IIIA IIIB IIIC IVA IVA IVB International Association for the Study of Lung Cancer,

29 Ausblick Bremnes RM et al. JTO Vol. 11 No. 6:

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32 Travis WD et al. JTO 2016; Vol. 11 No. 8: