December 27, 2009

2009 Non-Small Cell Lung Cancer Staging System (2)

Axial CT images show a large mass (stars) in the left lower lobe with a large left pleural effusion with focal pleural thickening (arrowheads). The lung mass is better seen on a post-thoracentesis image. Transbronchial biopsy revealed adenocarcioma and pleural fluid cytology confirmed the presence of malignant cells. Based on the new staging system, this patient has at least M1a disease.

Based on multiple data sources and available clinical outcome (overall survival), additional schemes to stage NSCLC are implemented in this 7th edition. The subgroups and staging grouping are based on the overall survival as a major determinant. For example, overall survival of patients with "satellite nodule in the same lobe" is similar to those with T3 -- therefore it is classified as T3.

What Have Changed in the New Edition?
  • Additional "satellite nodule in the same lobe" now classified as T3 (previously T4)
  • Additional "satellite nodule in the different ipsilateral lobe" now classified as T4 (previously M1)
  • No change in N staging, but a new node map has been developed to address the issue of boundaries between different nodal stations
  • M staging is now subdivided into M1a and M1b to address significantly different prognosis: "contralateral pulmonary nodule (malignant)" and "pleural dissemination" now classified as M1a; distant metastasis as M1b
Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest 2009;136:260-271.

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