Chest
Volume 111, Issue 6, June 1997, Pages 1710-1717
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Special Report
Revisions in the International System for Staging Lung Cancer

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Revisions in stage grouping of the TNM subsets (T=primary tumor, N=regional lymph nodes, M=distant metastasis) in the International System for Staging Lung Cancer have been adopted by the American Joint Committee on Cancer and the Union Internationale Contre le Cancer. These revisions were made to provide greater specificity for identifying patient groups with similar prognoses and treatment options with the least disruption of the present classification: T1N0M0, stage IA; T2N0M0, stage IB; T1N1M0, stage IIA; T2N1M0 and T3N0M0, stage IIB; and T3N1M0, T1N2M0, T2N2M0, T3N2M0, stage IIIA. The TNM subsets in stage IIIB—T4 any N M0, any T N3M0, and in stage IV—any T any N Ml, remain the same. Analysis of a collected database representing all clinical, surgical-pathologic, and follow-up information for 5,319 patients treated for primary lung cancer confirmed the validity of the TNM and stage grouping classification schema.

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Materials and Methods

The end results illustrating the revised stage grouping rules were derived from a collected series of patients. Clinical, surgical-pathologic, and follow-up information on 1,524 consecutive, previously untreated, patients who received their primary treatment for non-small cell lung cancer at the University of Texas M. D. Anderson Cancer Center from 1983 through 1988 was combined with a previously published classification research database5 (Table 1). In the duration covered by the collected

Prognostic Implications of Stage Grouping

Stage grouping (Table 3) involves the concept of combining subsets of patients classified according to TNM descriptors into categories or stages, each having generally similar treatment options and survival expectations. This classification hierarchy is useful for end results reports, particularly investigations involving small numbers of patients, and for rapid recall of the prognostic implications of various levels of the anatomic extent of disease. In the International Staging System schema,

Stage Grouping of the TNM Subsets

The revised stage grouping rules divide stage I and stage II into A and B categories and modify stage IIIA to more accurately represent the prognostic implications of the anatomic extent of disease in each TNM subset. The T1N0M0, T2N0M0, and T1N1M0 anatomic subsets are designated as separate entities, and the T3N0M0 category is placed in stage IIB, which is consistent with the end results for this group (Table 3).

The end results according to clinical (Table 8, top) and surgical (Table 8, bottom)

ACKNOWLEDGMENT

The author acknowledges the contributions of Kay E. Hermes, BS, Biomedical Analyst, to the research and writing of this report.

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Supported in part by the Clifton F. Mountain Foundation. Manuscript received January 2, 1997; revision accepted February 27, 1997.

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