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. 2025 Jun 3:222:115436.
doi: 10.1016/j.ejca.2025.115436. Epub 2025 Apr 15.

Validation of the 9th Tumor, Node, and Metastasis Staging System for Patients with Surgically Resected Non-Small Cell Lung Cancer

Shia Kim  1 , Yura Ahn  2 , Geun Dong Lee  1 , Sehoon Choi  1 , Hyeong Ryul Kim  1 , Yong-Hee Kim  1 , Dong Kwan Kim  1 , Seung-Il Park  1 , Jae Kwang Yun  3
Affiliations

Validation of the 9th Tumor, Node, and Metastasis Staging System for Patients with Surgically Resected Non-Small Cell Lung Cancer

Shia Kim et al. Eur J Cancer. .

Abstract

Introduction: The ninth edition of the tumor, node, and metastasis (TNM) classification system was recently published by the International Association for the Study of Lung Cancer staging project. This study aimed to validate the ninth edition of the TNM staging system, and compare its discrimination power with that of the eighth edition.

Methods: Patients who had undergone complete resection with systematic lymph node dissection for non-small cell lung cancer (NSCLC) were included in this retrospective analysis. Significant differences among adjacent TNM stage groupings were identified using a Cox regression model. The concordance index (C-index), Akaike Information Criterion (AIC), and R2 were calculated to assess the discriminatory power of the two classification systems.

Results: A total of 7429 patients (4325 male; interquartile range, 57-70 years) were analyzed. The median follow-up duration was 50.4 months (interquartile range, 18-69 months). Survival curves within adjacent stage groupings created according to the ninth edition exhibited significant differences for all groups when divided according to the clinical or pathological stage. Compared with that of the eighth edition, the ninth edition demonstrated an improved discriminatory ability, as evidenced by a higher C-index (0.769 vs. 0.767), lower AIC (26,820 vs. 26,851), and higher R2 (0.164 vs. 0.160) values.

Conclusions: Compared to the eighth edition of the TNM staging system, the ninth edition demonstrated improved prognostic accuracy and superior discriminatory ability for clinical and pathological stages.

Keywords: 9th TNM staging; Lung cancer; Non-small-cell lung cancer; Staging.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. The author is an Editorial Board Member/Editor-in-Chief/Associate Editor/Guest Editor for this journal and was not involved in the editorial review or the decision to publish this article. Disclosure statement The authors declare no conflicts of interest.

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