INTRODUCTION: Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. METHODS: A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. RESULTS: Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. CONCLUSION: For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.

The IASLC lung cancer staging project: Background data and proposals for the application of TNM staging rules to lung cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the TNM classification / Detterbeck, Frank C.; Marom, Edith M.; Arenberg, Douglas A.; Franklin, Wilbur A.; Nicholson, Andrew G.; Travis, William D.; Girard, Nicolas; Mazzone, Peter J.; Donington, Jessica S.; Tanoue, Lynn T.; Rusch, Valerie W.; Asamura, Hisao; Rami porta, R; Ruffini, Enrico; Filosso, Pier Luigi. - In: JOURNAL OF THORACIC ONCOLOGY. - ISSN 1556-0864. - 11:5(2016), pp. 666-680. [10.1016/j.jtho.2015.12.113]

The IASLC lung cancer staging project: Background data and proposals for the application of TNM staging rules to lung cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the TNM classification

FILOSSO, Pier Luigi
2016-01-01

Abstract

INTRODUCTION: Application of tumor, node, and metastasis (TNM) classification is difficult in patients with lung cancer presenting as multiple ground glass nodules or with diffuse pneumonic-type involvement. Clarification of how to do this is needed for the forthcoming eighth edition of TNM classification. METHODS: A subcommittee of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee conducted a systematic literature review to build an evidence base regarding such tumors. An iterative process that included an extended workgroup was used to develop proposals for TNM classification. RESULTS: Patients with multiple tumors with a prominent ground glass component on imaging or lepidic component on microscopy are being seen with increasing frequency. These tumors are associated with good survival after resection and a decreased propensity for nodal and extrathoracic metastases. Diffuse pneumonic-type involvement in the lung is associated with a worse prognosis, but also with a decreased propensity for nodal and distant metastases. CONCLUSION: For multifocal ground glass/lepidic tumors, we propose that the T category be determined by the highest T lesion, with either the number of tumors or m in parentheses to denote the multifocal nature, and that a single N and M category be used for all the lesions collectively-for example, T1a(3)N0M0 or T1b(m)N0M0. For diffuse pneumonic-type lung cancer we propose that the T category be designated by size (or T3) if in one lobe, as T4 if involving an ipsilateral different lobe, or as M1a if contralateral and that a single N and M category be used for all pulmonary areas of involvement.
11
5
666
680
The IASLC lung cancer staging project: Background data and proposals for the application of TNM staging rules to lung cancer presenting as multiple nodules with ground glass or lepidic features or a pneumonic type of involvement in the forthcoming eighth edition of the TNM classification / Detterbeck, Frank C.; Marom, Edith M.; Arenberg, Douglas A.; Franklin, Wilbur A.; Nicholson, Andrew G.; Travis, William D.; Girard, Nicolas; Mazzone, Peter J.; Donington, Jessica S.; Tanoue, Lynn T.; Rusch, Valerie W.; Asamura, Hisao; Rami porta, R; Ruffini, Enrico; Filosso, Pier Luigi. - In: JOURNAL OF THORACIC ONCOLOGY. - ISSN 1556-0864. - 11:5(2016), pp. 666-680. [10.1016/j.jtho.2015.12.113]
Detterbeck, Frank C.; Marom, Edith M.; Arenberg, Douglas A.; Franklin, Wilbur A.; Nicholson, Andrew G.; Travis, William D.; Girard, Nicolas; Mazzone, Peter J.; Donington, Jessica S.; Tanoue, Lynn T.; Rusch, Valerie W.; Asamura, Hisao; Rami porta, R; Ruffini, Enrico; Filosso, Pier Luigi
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11380/1294961
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