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New Tumour Staging System for Lung Cancer Released: Presented at WCLC

By Fred Gebhart

SAN FRANCISCO -- August 5, 2009 -- The International Association for the Study of Lung Cancer (IASLC) has published the first major revision of the TNM staging system for lung and pleural tumours since 1987.

The new system is part of the seventh edition of the International Union Against Cancer Classification of Malignant Tumours that will be published later this year. The IASLC released the lung and pleural tumour guidelines on August 3 here at the 13th World Conference on Lung Cancer (WCLC).

"This is the first real change in lung and pleural tumour staging since the fourth edition 20 years ago," said Peter Goldstraw, MD, IASLC Lung Cancer Staging Project and Imperial College, London, United Kingdom. "The new system is based on a database of more than 100,000 patients from 46 centres and 19 countries. That is a significant change from the prior system that was based largely on data from a single centre in the United States that was predominantly surgical."

The new staging system will bring important changes to clinical practice, Dr. Goldstraw continued. Tumour staging is a key factor in patient prognosis and is often the guiding factor in deciding which treatment or treatments are most appropriate for any specific patient.

Tumour staging is also a vital element in research. Tumour stage is almost universally used to set inclusion and exclusion criteria for participation in clinical trials. Tumour stage is also a benchmark in evaluating response to treatment. Dr. Goldstraw noted that the Southwest Oncology Group is already reanalysing some of its trial data using the new staging system in an attempt to refine earlier findings.

The new staging system includes major revisions to tumour size and tumour descriptions. The former staging system divided tumours into 2 size groups with 3 cm as the cut point. The new system has 5 size-based categories with cut points at 2, 3, 5, and 7 cm. The additional cut points will allow for more precise staging and treatment recommendations.

The new system also consolidates the Mountain-Dressler lymph node mapping system created in the United States and the Naruke system from Japan. The consolidated system gives clinicians and researchers worldwide the first-ever common set of descriptors for nodal involvement.

Also new in the seventh edition is a zonal chart to score nodal lesions. Prior systems used nodal stations, a localised descriptor that was most useful for surgeons. The zonal descriptor is useful in disciplines and more accurately describes bulky disease that involves more than 1 nodal station.

Subgroups of metastatic disease have also been revised to more accurately reflect survival rates, Dr. Goldstraw said.

[Presentation title: Implementation of IASLC Revised Staging System. Abstract PL3.1]

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