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Review
. 2024 Jul;19(7):1052-1072.
doi: 10.1016/j.jtho.2024.03.021. Epub 2024 Apr 1.

The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the Classification of Residual Tumor After Resection for the Forthcoming (Ninth) Edition of the TNM Classification of Lung Cancer

Frank C Detterbeck  1 , Marcin Ostrowski  2 , Hans Hoffmann  3 , Ramón Rami-Porta  4 , Ray U Osarogiagbon  5 , Jessica Donnington  6 , Maurizio Infante  7 , Mirella Marino  8 , Edith M Marom  9 , Jun Nakajima  10 , Andrew G Nicholson  11 , Paul van Schil  12 , William D Travis  13 , Ming S Tsao  14 , John G Edwards  15 , Hisao Asamura  16 ; Members of the Staging and Prognostic Factors Committee and Advisory Boards
Affiliations
Free article
Review

The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for Revision of the Classification of Residual Tumor After Resection for the Forthcoming (Ninth) Edition of the TNM Classification of Lung Cancer

Frank C Detterbeck et al. J Thorac Oncol. 2024 Jul.
Free article

Abstract

Introduction: The goal of surgical resection is to completely remove a cancer; it is useful to have a system to describe how well this was accomplished. This is captured by the residual tumor (R) classification, which is separate from the TNM classification that describes the anatomic extent of a cancer independent of treatment. The traditional R-classification designates as R0 a complete resection, as R1 a macroscopically complete resection but with microscopic tumor at the surgical margin, and as R2 a resection that leaves gross tumor behind. For lung cancer, an additional category encompasses situations in which the presence of residual tumor is uncertain.

Methods: This paper represents a comprehensive review of evidence regarding these R categories and the descriptors thereof, focusing on studies published after the year 2000 and with adjustment for potential confounders.

Results: Consistent discrimination between complete, uncertain, and incomplete resection is revealed with respect to overall survival. Evidence regarding specific descriptors is generally somewhat limited and only partially consistent; nevertheless, the data suggest retaining all descriptors but with clarifications to address ambiguities.

Conclusion: On the basis of this review, the R-classification for the ninth edition of stage classification of lung cancer is proposed to retain the same overall framework and descriptors, with more precise definitions of descriptors. These refinements should facilitate application and further research.

Keywords: Complete resection; Lung cancer; Residual disease; Surgery.

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Conflict of interest statement

Disclosure Drs. Asamura, Detterbeck, Edwards, Hoffmann, Infante, Marino, Nakajima, Ostrowski, Rami-Porta, Travis have nothing to disclose.Dr. Van Schil reports personal fees from BMS, personal fees from MSD, personal fees from Roche, from Janssen, outside the submitted work; and BACTS (Belgian Association for Cardiothoracic Surgery) treasurer - no fees, IASLC (International Association for the Study of Lung Cancer) president 2023-2025 - no feesDr. Tsao reports grants and personal fees from AstraZeneca, grants and personal fees from Bayer, grants and personal fees from Sanofi, personal fees from Daiichi Sankyo, personal fees from Amgen, personal fees from Abbvie, outside the submitted workDr. Donington reports Amgen: advisory board, AstraZeneca: advisory board and speaker, BMS: advisory board and speaker, Merck: advisory board and speaker, Roche/Genentech: advisory board and speaker.Dr. NICHOLSON reports personal fees from MERCK, personal fees from BOEHRINGER INGELHEIM, grants and personal fees from PFIZER, personal fees from NOVARTIS, personal fees from ASTRA ZENECA, personal fees from BRISTOL MYER SQUIB, personal fees from ROCHE, personal fees from ASTRA ZENECA, personal fees from ABBVIE, personal fees from ONCOLOGICA, personal fees from UPTODATE, personal fees from EUROPEAN SOCIETY OF ONOCLOGY, personal fees from LIBERUM, personal fees from TAKEDA UK, personal fees from SANOFI, outside the submitted work; .Dr. Marom reports other from boehringer ingelheim, other from AstraZeneca, other from Merck Sharp & Dohme, outside the submitted work; Raymond U. Osarogiagbon reports grants from National Cancer Institute, during the conduct of the study; personal fees from American Cancer Society, personal fees from Biodesix, personal fees from Genentech/Roche, personal fees from Lungevity Foundation, personal fees from National Cancer Institute, personal fees from Tryptych Healthcare Partners, personal fees from AstraZeneca, personal fees from GE Healthcare, personal fees from Eli Lilly, personal fees from Gilead Sciences, personal fees from Pfizer, outside the submitted work; In addition, Dr. Osarogiagbon has a patent Lymph node specimen collection kit issued, and a patent Method for collecting lymph nodes issued and Board Chair, Hope Foundation for Cancer Research (SWOG); Board of Scientific Advisors, National Cancer Institute; Steering Committee, National Lung Cancer Roundtable; Scientific Advisory Board, Lung Cancer Foundation of America; Scientific Advisory Board, GO2 Foundation; Scientific Advisory Board, Druckenmiller Center for Lung Cancer Research, Memorial Sloan Kettering Cancer Center; Scientific Advisory Board, LUNGevity Foundation. Founder, Oncobox Devices, Inc.

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