The International Association for the Study of Lung Cancer Staging Project for Lung Cancer: Proposals for the Revision of the N Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Lung Cancer

James Huang; Raymond U Osarogiagbon; Dorothy J Giroux; Katherine K Nishimura; Andrea Bille; Giuseppe Cardillo; Frank Detterbeck; Kemp Kernstine; Hong Kwan Kim; Yolande Lievens; Eric Lim; Edith Marom; Helmut Prosch; Paul Martin Putora; Ramon Rami-Porta; David Rice; Gaetano Rocco; Valerie W Rusch; Isabelle Opitz; Francisco Suarez Vasquez; Paul Van Schil; Chi-Fu Jeffrey Yang; Hisao Asamura; Members of the Staging and Prognostic Factors Committee, Members of the Advisory Boards, and Participating Institutions of the Lung Cancer Domain

doi:10.1016/j.jtho.2023.10.012

The International Association for the Study of Lung Cancer Staging Project for Lung Cancer: Proposals for the Revision of the N Descriptors in the Forthcoming Ninth Edition of the TNM Classification for Lung Cancer

J Thorac Oncol. 2023 Oct 20:S1556-0864(23)02310-9. doi: 10.1016/j.jtho.2023.10.012. Online ahead of print.

Authors

James Huang¹, Raymond U Osarogiagbon², Dorothy J Giroux³, Katherine K Nishimura³, Andrea Bille⁴, Giuseppe Cardillo⁵, Frank Detterbeck⁶, Kemp Kernstine⁷, Hong Kwan Kim⁸, Yolande Lievens⁹, Eric Lim¹⁰, Edith Marom¹¹, Helmut Prosch¹², Paul Martin Putora¹³, Ramon Rami-Porta¹⁴, David Rice¹⁵, Gaetano Rocco¹⁶, Valerie W Rusch¹⁶, Isabelle Opitz¹⁷, Francisco Suarez Vasquez¹⁸, Paul Van Schil¹⁹, Chi-Fu Jeffrey Yang²⁰, Hisao Asamura²¹; Members of the Staging and Prognostic Factors Committee, Members of the Advisory Boards, and Participating Institutions of the Lung Cancer Domain

Affiliations

¹ Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: huangj@mskcc.org.
² Thoracic Oncology Research Group, Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
³ Cancer Research and Biostatistics, Seattle, Washington.
⁴ Department of Thoracic Surgery, Guys Hospital, London, United Kingdom; School of Cancer and Pharmaceutical Sciences, Kings College University, London, United Kingdom.
⁵ Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy; UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy.
⁶ Department of Surgery, Yale University, New Haven, Connecticut.
⁷ Division of Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
⁸ Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
⁹ Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium.
¹⁰ Imperial College London, London, United Kingdom; The Academic Division of Thoracic Surgery, Royal Brompton Hospital, London, United Kingdom.
¹¹ Department of Diagnostic Imaging, Chaim Sheba Medical Center, Tel-Aviv University, Ramat Gan, Israel.
¹² Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
¹³ Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland; Department of Radiation Oncology, University of Bern, Switzerland.
¹⁴ Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centres for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
¹⁵ Department of Thoracic and Cardiovascular Surgery, University of Texas, MD Anderson Cancer Center, Houston, Texas.
¹⁶ Thoracic Service, Memorial Sloan Kettering Cancer Center, New York, New York.
¹⁷ Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
¹⁸ Department of Surgery, Clínica Santa María, Universidad de Los Andes, Santiago, Chile.
¹⁹ Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Antwerp University, Antwerp, Belgium.
²⁰ Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
²¹ Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.

PMID: 37866624
DOI: 10.1016/j.jtho.2023.10.012

Abstract

Introduction: The accurate assessment of nodal (N) status is crucial to the management and prognostication of nonmetastatic NSCLC. We sought to determine whether the current N descriptors should be maintained or revised for the upcoming ninth edition of the international TNM lung cancer staging system.

Methods: Data were assembled by the International Association for the Study of Lung Cancer on patients with NSCLC, detailing both clinical and pathologic N status, with information about anatomical location and individual station-level identification. Survival was calculated by the Kaplan-Meier method and prognostic groups were assessed by a Cox regression analysis.

Results: Data for clinical N and pathologic N status were available in 45,032 and 35,009 patients, respectively. The current N0 to N3 descriptors for both clinical N and pathologic N categories reflect prognostically distinct groups. Furthermore, single-station N2 involvement (N2a) exhibited a better prognosis than multistation N2 involvement (N2b) in both clinical and pathologic classifications, and the differences between all neighboring nodal subcategories were highly significant. The prognostic differences between N2a and N2b were robust and consistent across resection status, histologic type, T category, and geographic region.

Conclusions: The current N descriptors should be maintained, with the addition of new subdescriptors to N2 for single-station involvement (N2a) and multiple-station involvement (N2b).

Keywords: Lung cancer; Lung cancer staging; Lymph node metastasis; N component; N descriptors; TNM classification.