The science behind the 7th edition Tumour, Node, Metastasis staging system for lung cancer

Authors

  • HENRY M. MARSHALL,

    Corresponding author
    1. Department of Thoracic Medicine, The Prince Charles Hospital
    2. UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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    • The first two authors contributed equally to this paper.

  • STEVEN C. LEONG,

    1. Department of Thoracic Medicine, The Prince Charles Hospital
    2. UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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    • The first two authors contributed equally to this paper.

  • RAYLEEN V. BOWMAN,

    1. Department of Thoracic Medicine, The Prince Charles Hospital
    2. UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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  • IAN A. YANG,

    1. Department of Thoracic Medicine, The Prince Charles Hospital
    2. UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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  • KWUN M. FONG

    1. Department of Thoracic Medicine, The Prince Charles Hospital
    2. UQ Thoracic Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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  • The Authors: Dr Steven Leong, MBBS (Hons), FRACP, is a Thoracic and Sleep Physician with an interest in early lung cancer diagnosis and advanced bronchoscopy. He is currently a research fellow at The Prince Charles Hospital, Brisbane. Dr Henry Marshall, BM, MRCP, FRACP is a Thoracic Physician at The Prince Charles Hospital with a special interest in thoracic malignancy and an NHMRC Postgraduate Medical Research Scholar at the University of Queensland Thoracic Research Centre. His PhD thesis is based on lung cancer screening using low-dose CT. Dr Ian Yang MBBS (Hons), PhD, FRACP, Grad Dip Clin Epi., is a Consultant Thoracic Physician at The Prince Charles Hospital, Associate Professor and Head of the Northside Clinical School, School of Medicine, The University of Queensland, Brisbane. His clinical work is in the field of thoracic medicine, and his research focuses on gene-environmental interaction in COPD, asthma, lung cancer and air pollution. He is involved in the training of higher degree students in translational research into lung diseases. Associate Professor Rayleen Bowman, MBBS, FRACP, Grad Cert Educ PhD, is clinician-researcher with a major interest in the pathogenesis, diagnosis and treatment of pulmonary and pleural malignancies. As a full-time consultant thoracic physician, she treats many patients with lung cancer and mesothelioma, and is expert in the clinical management of these patients. She has extensive experience in the clinical and molecular aspects of lung cancer and mesothelioma. Her PhD students and Honours students are pursuing topics in these fields. She is currently Chief Investigator A of project grants awarded by the Dust Diseases Board and Cancer Australia. Professor Kwun Fong, MBBS(Lon), FRACP, PhD, is a Thoracic and Sleep Physician at The Prince Charles Hospital, Brisbane and a Professor with the School of Medicine at the University of Queensland, practising general thoracic and sleep medicine with a special interest in thoracic malignancies. He is involved in laboratory based molecular and genomic research and translational trials of diagnosis and treatment in lung cancer and lung diseases. He was the inaugural Chair of the Australasian Lung Cancer Trials Group and serves as Chair of the Australian Lung Foundation's Lung Cancer Consultative Group, Chair of Cancer Australia Lung Cancer Advisory Group, Co-Editor of the Cochrane Lung Cancer Review Group and Associate Editor for the Journal of Thoracic Oncology.

  • SERIES EDITORS: JOHN E HEFFNER AND DAVID CL LAM

Henry Marshall, The Prince Charles Hospital, Rode Road, Chermside, Brisbane, Qld 4032, Australia. Email: henry_marshall@health.qld.gov.au

ABSTRACT

The Tumour, Node, Metastasis (TNM) system for classifying lung cancer is the cornerstone of modern lung cancer treatment and underpins comparative research; yet is continuously evolving through updated revisions. The recently published Union for International Cancer Control 7th Edition TNM Classification for lung cancer addresses many of its predecessor's shortcomings and has been subject to rigorous evidence-based methodology. It is based on a retrospective analysis of over 80 000 lung cancer patients treated between 1990 and 2000 carried out by the International Association for the Study of Lung Cancer. The dataset was truly international and included patients treated by all modalities. Extensive internal and external validation of the findings has ensured that the recommendations are robust and generalizable. For the first time, a single classification system has been shown to be applicable not only to non-small cell lung cancer, but also to be of prognostic significance in small cell lung cancer and bronchopulmonary carcinoid tumours.

We review the history of the Union for International Cancer Control TNM staging system, the changes in the most recent 7th edition and the strength of the scientific basis motivating these changes. Limitations of the current staging edition are explored, post-publication independent validation studies are reviewed, and the future of TNM staging for lung cancer is discussed.

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