Comments on the Eighth Edition of the TNM Classification for Lung Cancer Radical changes and limitations: Does size matter?
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Cardiothoracic surgeon, Thorax Center, Corfu, Greece
Anesthesiologist, Algos Pain Center, Corfu, Greece
Department of Thoracic Surgery, Metaxa Memorial Cancer Hospital, Piraeus, Greece
Department of Thoracic Surgery, Sismanogleio General Hospital, Athens, Greece
Oncology Unit, 3rd Department of Medicine, Athens Medical School, Sotiria Chest Diseases Hospital, Athens, Greece
Department of Surgery, Ioannina University Hospital, Ioannina Greece
Department of Cardiothoracic Surgery, Ioannina University Hospital, Ioannina, Greece
Stefanos Nikolouzos   

Thorax Centre, 2A Ioannis Romanos Street, 49132 Corfu, Greece
Pneumon 2017;30(2):77–84
Staging of cancer at the time of diagnosis is the most important predictor of survival, and treatments options should be based on the stage. The aim of this overview is to discuss the changes in the 8th classification of lung cancer and its impact on predicting patients’ prognosis. Potential limitations of the classification and future directions are discussed.

A systematic literature search was performed to identify relevant reports. Studies and articles were identified using online searches of The U.S. National Library of Medicine via www.pubmed.com. The whole article is based on the IASLC Staging and Prognostic Factors Committee report. An international lung cancer database was developed from 35 sources in 16 countries around the globe with staging and outcome data on 94708 lung cancer cases.

This new edition of lung cancer TNM staging placed additional emphasis on tumor size and size cut points have further added. The node classification remained unchanged in the new edition. It also emphasizes on the different prognostic value of single o multiple metastatic foci.

New staging is based on analyzing survival in large databases based on tumor size and disease proliferation and therefore is expected to assess an individual patient’s prognosis more accurately. It is evident that an improved survival may eflects improvements in diagnosis and treatment. This eighth edition of the TNM classification for lung cancer placed additional emphasis on tumor size.

Siegel RL, Miller KD, Jemal A . Cancer Statistics, 2016. CA Cancer J Clin 2016; 66:7-30.
Harris JE. Cigarette smoking among successive birth cohorts of men and women in the United States during 1900-80. J Natl Cancer Inst 1983; 71:473-9.
Jemal A, Ma J, Rosenberg PS, Siegel R, Anderson WF. Increasing lung cancer death rates among young women in southern and midwestern states. J Clin Oncol 2012;30:2739-44.
National Lung Screening Trial Research Team, Aberle DR, Adams AM, et al. Reduced lung-cancer mortality with low dose com puted tomographic screening. N Engl J Med 2011; 365:395-409.
Welch HG, Schwartz LM, Woloshin S. Are increasing 5-year survival rates evidence of success against cancer? JAMA 2000;283:2975-8.
Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2012. Bethesda, MD: National Cancer Institute; 2015.
Jemal A, Thun MJ, Ries LA, et al. Annual report to the nation on the status of cancer, 1975-2005, featuring trends in lung cancer, tobacco use, and tobacco control. J Natl Cancer Inst 2008; 100:1672-94.
Holford TR, Meza R, Warner KE, et al. Tobacco control and the reduction in smoking-related premature deaths in the United States, 1964 2012. JAMA 2014; 311:164-71.
US Department of Health and Human Services. The Health Consequences of Smoking 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
Siegel RL, Jacobs EJ, Newton CC, et al. Deaths due to cigarette smoking for 12 smoking- related cancers in the United States. JAMA Intern Med 2015; 175:1574-6.
Rami-Porta R, Crowley JJ, Goldstraw P. The revised TNM staging system for lung cancer. Ann Thorac Cardiovasc Surg 2009;15:4-9.
Mirsadraee S, Oswal D, Alizadeh Y, et al. The 7th lung cancer TNM classification and staging system: Review of the changes and implications. World J Radiol 2012;4:128-34.
Rami-Porta R, Bolejack V, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for the revisions of the T descriptors in the forthcoming eighth edition of the TNM classification for lung cancer. J Thorac Oncol 2015; 10:990–1003.
Eberhardt WEE, Mitchell A, Crowley J, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the M descriptors in the forthcoming (8th) edition of the TNM classification of lung cancer. J Thorac Oncol 2015; 10:1515–22.
Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest 1997;111:1718-23.
Toloza EM, Harpole L, Detterbeck F, et al. Invasive staging of non-small cell lung cancer: a review of the current evidence. Chest 2003;123:157S-66S.
Luke WP, Pearson FG, Todd TR, et al. Prospective evaluation of mediastinoscopy for assessment of carcinoma of the lung. J Thorac Cardiovasc Surg 1986;91:53-6.
Coughlin M, Deslauriers J, Beaulieu M, et al. Role of mediastinoscopy in pretreatment staging of patients with primary lung cancer. Ann Thorac Surg 1985;40:556-60.
Ømark Petersen H, Eckardt J, Hakami A, et al. The value of mediastinal staging with endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer. Eur J Cardiothorac Surg 2009;36:465-8.
Rintoul RC, Skwarski KM, Murchison JT, et al. Endobronchial and endoscopic ultrasound-guided real-time fine-needle aspiration for mediastinal staging. Eur Respir J 2005;25:416-21.
Wallace MB, Pascual JM, Raimondo M, et al. Minimally invasive endoscopic staging of suspected lung cancer. JAMA 2008; 299:540-6.
Nikolouzos S, Zacharia G, Charpidou A et al. Invasive Techniques in Diagnosis and Staging of Lung Cancer. HJS 2014;86:130-7.
Goldstraw P, Chansky K , Crowley J et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016;11:39-51.