T, N, and M descriptors for the eighth edition of TNM classification for lung cancer

T: Primary tumor
Tx	Primary tumor cannot be assessed or tumor proven by presence of malignant cells in sputum or bronchial washings but not visualized by imaging or bronchoscopy
T0	No evidence of primary tumor
Tis	Carcinoma in situ
T1	Tumor ≤3 cm in greatest dimension surrounded by lung or visceral pleura without bronchoscopic evidence of invasion more proximal than the lobar bronchus (ie, not in the main bronchus)*
T1a(mi)	Minimally invasive adenocarcinoma^¶
T1a	Tumor ≤1 cm in greatest dimension*
T1b	Tumor >1 cm but ≤2 cm in greatest dimension*
T1c	Tumor >2 cm but ≤3 cm in greatest dimension*
T2	Tumor >3 cm but ≤5 cm or tumor with any of the following features:^Δ Involves main bronchus regardless of distance from the carina but without involvement of the carina Invades visceral pleura Associated with atelectasis or obstructive pneumonitis that extends to the hilar region, involving part or all of the lung
T2a	Tumor >3 cm but ≤4 cm in greatest dimension
T2b	Tumor >4 cm but ≤5 cm in greatest dimension
T3	Tumor >5 cm but ≤7 cm in greatest dimension or associated with separate tumor nodule(s) in the same lobe as the primary tumor or directly invades any of the following structures: chest wall (including the parietal pleura and superior sulcus tumors), phrenic nerve, parietal pericardium
T4	Tumor >7 cm in greatest dimension or associated with separate tumor nodule(s) in a different ipsilateral lobe than that of the primary tumor or invades any of the following structures: diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, and carina
N: Regional lymph node involvement
Nx	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastasis
N1	Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2	Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3	Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)
M: Distant metastasis
M0	No distant metastasis
M1	Distant metastasis present
M1a	Separate tumor nodule(s) in a contralateral lobe; tumor with pleural or pericardial nodule(s) or malignant pleural or pericardial effusion^◊
M1b	Single extrathoracic metastasis^§
M1c	Multiple extrathoracic metastases in one or more organs
Stage groupings
Occult carcinoma	TX	N0	M0
Stage 0	Tis	N0	M0
Stage IA1	T1a(mi)	N0	M0
Stage IA1	T1a	N0	M0
Stage IA2	T1b	N0	M0
Stage IA3	T1c	N0	M0
Stage IB	T2a	N0	M0
Stage IIA	T2b	N0	M0
Stage IIB	T1a to c	N1	M0
	T2a	N1	M0
	T2b	N1	M0
	T3	N0	M0
Stage IIIA	T1a to c	N2	M0
	T2a to b	N2	M0
	T3	N1	M0
	T4	N0	M0
	T4	N1	M0
Stage IIIB	T1a to c	N3	M0
	T2a to b	N3	M0
	T3	N2	M0
	T4	N2	M0
Stage IIIC	T3	N3	M0
Stage IIIC	T4	N3	M0
Stage IVA	Any T	Any N	M1a
Stage IVA	Any T	Any N	M1b
Stage IVB	Any T	Any N	M1c

NOTE: Changes to the seventh edition are in bold.

TNM: tumor, node, metastasis; Tis: carcinoma in situ; T1a(mi): minimally invasive adenocarcinoma.
* The uncommon superficial spreading tumor of any size with its invasive component limited to the bronchial wall, which may extend proximal to the main bronchus, is also classified as T1a.
¶ Solitary adenocarcinoma, ≤3 cm with a predominately lepidic pattern and ≤5 mm invasion in any one focus.
Δ T2 tumors with these features are classified as T2a if ≤4 cm in greatest dimension or if size cannot be determined, and T2b if >4 cm but ≤5 cm in greatest dimension.
◊ Most pleural (pericardial) effusions with lung cancer are due to tumor. In a few patients, however, multiple microscopic examinations of pleural (pericardial) fluid are negative for tumor and the fluid is nonbloody and not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging descriptor.
§ This includes involvement of a single distant (nonregional) lymph node.

Reproduced from: Goldstraw P, Chansky K, Crowley J, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol 2016; 11:39. Table used with the permission of Elsevier Inc. All rights reserved.

Graphic 109805 Version 1.0

خرید پکیج

T, N, and M descriptors for the eighth edition of TNM classification for lung cancer