Malignant pleural mesothelioma TNM staging AJCC 8th edition

Primary tumor (T)
T category	T criteria
TX	Primary tumor cannot be assessed
T0	No evidence of primary tumor
T1	Tumor limited to the ipsilateral parietal pleura with or without involvement of: Visceral pleura Mediastinal pleura Diaphragmatic pleura
T2	Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: Involvement of diaphragmatic muscle Extension of tumor from visceral pleura into the underlying pulmonary parenchyma
T3	Describes locally advanced but potentially resectable tumor. Tumor involving all the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: Involvement of the endothoracic fascia Extension into the mediastinal fat Solitary, completely resectable focus of tumor extending into the soft tissues of the chest wall Nontransmural involvement of the pericardium
T4	Describes locally advanced technically unresectable tumor. Tumor involving all the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with at least one of the following features: Diffuse extension or multifocal masses of tumor in the chest wall, with or without associated rib destruction Direct transdiaphragmatic extension of tumor to the peritoneum Direct extension of tumor to the contralateral pleura Direct extension of tumor to mediastinal organs Direct extension of tumor into the spine Tumor extending through to the internal surface of the pericardium with or without a pericardial effusion, or tumor involving the myocardium
Regional lymph nodes (N)
N category	N criteria
NX	Regional lymph nodes cannot be assessed
N0	No regional lymph node metastases
N1	Metastases in the ipsilateral bronchopulmonary, hilar, or mediastinal (including the internal mammary, peridiaphragmatic, pericardial fat pad, or intercostal) lymph nodes
N2	Metastases in the contralateral mediastinal, ipsilateral, or contralateral supraclavicular lymph nodes
Distant metastasis (M)
M category	M criteria
M0	No distant metastasis
M1	Distant metastasis present
Prognostic stage groups
When T is...	And N is...	And M is...	Then the stage group is...
T1	N0	M0	IA
T2 or T3	N0	M0	IB
T1	N1	M0	II
T2	N1	M0	II
T3	N1	M0	IIIA
T1-3	N2	M0	IIIB
T4	Any N	M0	IIIB
Any T	Any N	M1	IV

TNM: tumor, node, metastasis; AJCC: American Joint Committee on Cancer.

Used with permission of the American College of Surgeons, Chicago, Illinois. The original source for this information is the AJCC Cancer Staging Manual, Eighth Edition (2017) published by Springer International Publishing. Corrected at 4th printing, 2018.

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Malignant pleural mesothelioma TNM staging AJCC 8th edition