13 th Cambridge Chest Meeting 2015. The 8 th Edition of TNM for Lung Cancer: The IASLC Proposals. Peter Goldstraw, Honorary Consultant Thoracic Surgeon, Royal Brompton Hospital, Emeritus Professor of Thoracic Surgery, Imperial College, London, UK.
Staging and Prognostic Factors Committee of the IASLC Past-Chair/Chair/Chair-Elect Lung Cancer Domain Chairperson Mesothelioma Domain Chairperson Thymoma Domain Chairperson Oesophageal Ca. Domain Chairperson Subcommittees(x n) -Chairperson (x 1) -Members (x n) -Liaison w/ab(x 1) Subcommittees(x n) -Chairperson (x 1) -Members (x n) -Liaison w/ab(x 1) Subcommittees(x n) -Chairperson (x 1) -Members (x n) -Liaison w/ab(x 1) Subcommittees(x n) -Chairperson (x 1) -Members (x n) -Liaison w/ab(x 1) Advisory Board Advisory Board Advisory Board Advisory Board Links with UICC, AJCC, IMIG, ITMIG, WECC, and others
Thymic Epithelial Tumours Collaboration between IASLC and ITMIG. 10,808 cases from 105 institutions globally. Publications to date: IASLC/ITMIS TNM Staging Project, Detterbeck F et al, JTO 2013;8:1467-1473. Stage Groupings, Detterbeck F et al, JTO 2014;9:S65-72. T Component, Nicholson A G et al, JTO 2014;9:S73-80. N and M, Kondo K et al, JTO 2014;9:S81-87. Nodal Map, Bhora F Y et al, JTO 2014;9:S88-96.
Malignant Pleural Mesothelioma Collaboration between IASLC and IMIG. Retrospective data on 3,101 cases and 1,558 prospectively collected cases. Publications to date: Uniform definitions of surgical procedures. Rice D et al, JTO 2011;6:1304-1312. Retrospective database. Rusch V W et al, JTO 2012;7: 1631-1639. Supplementary Prognostic Factors. Pass H I, JTO 2014;9:856-864. Analysis being undertaken, recommendations for T, N, M and Stage will be published in JTO mid 2015.
Cancer of Esophagus and Esophago-Gastic Junction Worldwide Esophageal Cancer Collaborative (WECC) collecting and analyzing cases. Over 10,000 cases collected, treated by surgery and other modalities. MOU signed with IASLC for development and distribution of educational materials. Presently being analyzed. Will be published in JTO mid 2015. Will be included in IASLC Manual and Handbook of Staging in Thoracic Oncology.
Lung Cancer A new data base was created following the successful conclusion of the previous revision. 94,708 cases (4,667 EDC) collected from 35 centres in 16 countries recruited 1999-2010. New data base published: Rami-Porta R et al, JTO 2014;9: 1618-1624. Proposals on T, N, M categories analyzed and papers in preparation for JTO, submission early 2015. Stage Groupings and Validation being analyzed, publication anticipated mid 2015.
Health Warning! The following slides show preliminary analyses which might form the basis of proposals for the 8 th Edition of TNM for Lung Cancer.
Lung Cancer - T category Proposals (1). Retain 7e size cut points. Create new cut points at 1cm and 4 cm. Subdivide T1: T1a: 1 cm; T1b: >1 & 2 cm; T1c: < 2cm & 3 cm. Redefine T2a as >3-4 cm. Redefine T2b as >4-5 cm. Reclassify tumours >5 cms but =/< 7cms as T3. Reclassify tumours > 7cms as T4.
Lung Cancer - T category Proposals (2). Reclassify tumours invading diaphragm as T4. Confirm the prognostic importance of VPI and validate PL categories. Remove rarely used descriptors, i.e. Mediastinal invasion. Propose that T size is based on solid/invasive element in mixed attenuation lesions.
Lung Cancer - N category Proposals. Retain 7 th edition N categories. Some interesting pn data showing the number of stations/nodes/zones may be more important than anatomical location did not conform to validation process but may be a Proposal for Testing. pn1a single N1 station involvement. pn1b multiple N1 station involvement. pn2a1 single skip N2 station involvement. pn2a2 single N2 station with N1 positive station(s). pn2b multiple N2 station involvement.
Lung Cancer - M category Proposals. Retain M1a category for intrathoracic metastases. Reclassify M1b as single distant metastasis in one organ. Create M1c for multiple metastases in a single or multiple organs. Consequent changes for Stage IVA and B
Proposed Stage Groups (1). Stage IA (1-3) T1a-c, N0 M0 Stage IB T2a, N0 M0 Stage IIA T2b, N0 M0 Stage IIB T3, N0 M0 T1-2, N1 M0 Stage IIIA T3, N1 M0 T4, N0-1 M0 T1-2, N2 M0
Proposed Stage Groups (2). Stage IIIB T1-2, N3 M0 T3-4, N2 M0 Stage IIIC T3-4, N3 M0 Stage IVA Stage IVB T any, N any M1a-b T any, N any M1c
8 th Edition of TNM All proposals will be first published in JTO 2014-15, free to non-members of IASLC. IASLC will submit proposals to UICC/AJCC mid 2015. Final Proposals will feature in 15 th WCLC in Denver 6-9 th September 2015. IASLC educational products available at WCLC Vienna, free/discounted for members. To be enacted January 2017.
https://medic3.cardiff.ac.uk/uicc_uk_tnm/index.php