Future Perspectives on the TNM Staging for Lung Cancer

Simple Summary The tumor, lymph node, and metastases classification of lung cancer describes how big the tumor is and what structures it invades; whether the lymph nodes are involved or not, and, if they are involved, where they are in the chest; and whether there are tumor implants in other organs distant from the lung. This classification of lung cancer was proposed in 1966 and it has undergone periodic revisions. The revisions for its 7th and 8th editions were based on a large amount of international data from patients treated with different therapeutic modalities. New data are being registered now to inform the forthcoming 9th edition. A potential innovation of this edition will be the combination of this classification with other prognostic factors, such as mutations of the genetic code of the cancer cells among others, to achieve a more personalized prognosis for individual patients. Since its conception by Pierre Denoix in the mid-20th century, the tumor, node, and metastasis (TNM) classification has undergone seven revisions. The North American database managed by Clifton Mountain was used to inform the 2nd to the 6th editions, and an international database collected by the International Association for the Study of Lung Cancer, promoted by Peter Goldstraw, was used to inform the 7th and the 8th editions. In these two latest editions, it was evident that the impact of tumor size was much greater than it was suggested in previous editions; that the amount of nodal disease had prognostic relevance; and that the number and location of the distant metastases had prognostic implications. However, the TNM classification is not the only prognostic factor. Data are being collected now to inform the 9th edition of the TNM classification, scheduled for publication in 2024. Patient-, environment-, and tumor-related factors, including biomarkers (genetic biomarkers, copy number alterations, and protein alterations) are being collected to combine them in prognostic groups to enhance the prognosis provided by the mere anatomic extent of the tumor, and to offer a more personalized prognosis to an individual patient. International collaboration is essential to build a large and detailed database to achieve these objectives.

Automated summary

The classification of lung cancer based on tumor, lymph node, and metastases has undergone several revisions since its proposal in 1966. The upcoming 9th edition is expected to combine this classification with other prognostic factors to provide a more personalized prognosis for individual patients. International collaboration is crucial in building a comprehensive database to achieve this objective.