New TNM classification: achievements and hurdles

Abstract

The 7th edition of TNM for Lung Cancer represented a major advance from previous editions, in the process of revision, the size and breadth of the data base used, its international character, the intensity of the analysis and the critical nature of the internal and external validation undertaken before its launch in January 2010. This all came about by the involvement of the International Association for the Study of Lung Cancer (IASLC), which assumed the role previously performed by Dr. Mountain, of developing data-driven revisions for the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC). In taking on this task the IASLC made the global lung cancer community aware of the limitations of previous revisions and now stand accountable and subject to the same scrutiny. In this article we describe the achievements of the IASLC TNM and Prognostic Factors Committee, but also the short-comings of the 7th edition, as an essential step towards rectifying deficiencies and further improving the classification in future revisions.

Keywords: Lung cancer; prognostic factors; staging.

Figure 1

The IASLC Nodal Map, reconciling the discrepancies between the Mountain/Dressler and Naruke maps. Each nodal station is colour-coded and listed. Those within a distinct nodal “zone” are grouped within the box. Reprinted courtesy of the International Association for the Study of Lung Cancer and with permission of Aletta Frazier, MD. Copyright ©2009, 2010 Aletta Ann Frazier, MD.