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강 창 현 서울대학교병원 흉부외과 서울대학교 의과대학

THE NEW LUNG CANCER STAGE CLASSIFICATION. 강 창 현 서울대학교병원 흉부외과 서울대학교 의과대학. Communication. Evaluation. Staging. Treatment. Prognosis. Research. TNM based stage. AJCC (1977). UICC (1958). Collaboration since 1982. AJCC Cancer Staging Manual editions. References.

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강 창 현 서울대학교병원 흉부외과 서울대학교 의과대학

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  1. THE NEW LUNG CANCER STAGE CLASSIFICATION 강 창 현 서울대학교병원 흉부외과 서울대학교 의과대학

  2. Communication Evaluation Staging Treatment Prognosis Research

  3. TNM based stage AJCC(1977) UICC(1958) Collaboration since 1982

  4. AJCC Cancer Staging Manual editions

  5. References • T-descriptors JTO 2007 • N-descriptors JTO 2007 • M-descriptors JTO 2007 • Stage grouping JTO 2007 • Validation JTO 2007

  6. References • SCLC (clinical staging) JTO 2007 • SCLC (pathological staging) JTO 2009 • Carcinoid tumors JTO 2008 • Additional prognostic factor JTO 2008 • IASLC nodal map JTO 2009

  7. AJCC 7th edition • Based on staging project by IASLC • International multi-institute data • Internal and external validation

  8. IASLC staging project

  9. IASLC database Time Frame 1990 ~ 2000 Source of data 45 sources from 20 countries

  10. Numbers of cases

  11. Treatment modalities Surgery+ Chemo4% Surgery+ RT5% Tri-modality3% Chemo+ RT12%

  12. Distribution by continent

  13. Validation Internal External By Data source Geographical regions By SEER data 1998-2000 Literature review

  14. Numbers analyzed • T descriptors 18,198 • N descriptors 28,371 • pN1 & pN2 2,876 • M descriptors 6,596 • SCLC (clinical) 8,088 • SCLC (Pathologic) 349 • Carcinoid tumor 513

  15. T-descriptors • Cutpoints of tumor size • Malignant pleural effusion • Separate nodules • Other T2 descriptors • Other T3 descriptors • Other T4 descriptors

  16. New cutpoints in size

  17. T1 learning set (n=2,284) T2 learning set (n=2607)

  18. Separate nodules & Malignant effusion

  19. N-descriptors • Verification of N1, N2, & N3 • Location of involved LNs • Number of involved LN stations • Skip metastasis • Anatomical “zones”

  20. Negative results • Peripheral specific LNs • Single specific LN zones • Presence of skip metastasisdid not had prognostic significance(except LUL with AP zone single metastasis)

  21. Positive results? • N1a single N1 zone • N1b Multiple N1 zone • N2a Single N2 zone • N2b Multiple N2 zone

  22. Overall disease burden, rather than anatomical location may have the most important influence on outcome

  23. Suggestions • Six Nodal zones • Subdivision to 3 prognostic groups • N1a • N1b & N2a • N2b • No change of current N-descriptors

  24. Discrepancy in nodal maps MD-ATS map(Mountain-Dresler modification of American Thoracic Society map) Naruke map(Japan Lung Cancer Society map) vs.

  25. M-descriptors • Separate nodules • Same lobe • Same lung • Contralateral lung • Malignant pleural effusion • Distant metastasis • Site of interest (brain) • Single vs. multiple

  26. Stage grouping

  27. AJCC the 6th edition

  28. AJCC the 7th edition

  29. Small cell lung cancer

  30. Carcinoid tumor

  31. Potential prognostic factors • Tumor characteristics • Patients characteristics • Laboratory parameters • Tumor biology

  32. Potential prognostic factors

  33. Changes in the 7th edition • Recommended for the classification of both NSCLC and SCLC and for carcinoid tumors • T classification • T1a (≤2cm) and T1b (>2-3cm) • T2a (>3-5cm) and T2b (>5-7cm) • T2 (>7cm) → T3 • Multiple tumor nodules in the same lobe → T3 • Multiple tumor nodules in the same lung → T4

  34. Changes in the 7th edition • No changes in N classification • But new international nodal map was proposed • M classification • Malignant pleural or pericardial effusion → M1a • Separate tumor nodules in contralateral lung → M1a • M1b designates distant metastasis • MX designation has been eliminated

  35. Limitations • Lack of detailed data in each descriptors • Too small numbers in specific category • Different lymph node maps • Biased distribution in treatment modality • Effect of treatment had not been considered

  36. New IASLC Prospective project • Prospective data acquisition • International multi-institute study • Complete set of data • Including non-anatomical prognostic factors

  37. Timetable • 2009-2010 Data collection • 2011-2012 Follow-up • 2013 Data analysis • Jan 2014 Submission of recommendations to UICC and AJCC • Jan – July 2014 Publication in JTO • 2016 Publication of 8th edition of TNM classification by the UICC and AJCC

  38. Future

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