The New International Staging System Lung Cancer

Transcription

1 The New International Staging System Lung Cancer Valerie W. Rusch, MD Chief, Thoracic Surgery Memorial Sloan-Kettering Cancer Center Chair, Lung and Esophagus Task Force, American Joint Commission on Cancer Member, IASLC Staging Committee

2 HISTORY OF STAGING TNM Concept Describes extent of tumor: local (T = tumor) regional (N = nodes) distant (M = metastasis) Developed by Pierre Denoix Accepted by UICC in 1953 as basis for classification of anatomical extent of cancer Incorporated in 1 st edition of staging manual, 1968

3 HISTORY OF STAGING: UICC and AJCC From s, variations among staging systems 1987: Reconciliation of AJCC and UICC staging system Currently, AJCC and UICC agree jointly on revisions and publish simultaneously AJCC / UICC staging systems used worldwide and govern all US state and national tumor registries

4 Clifton F. Mountain, Chief, Thoracic Surgery, M.D. Anderson Hospital and Tumor Institute, (Houston, TX)

5 LUNG CANCER STAGING In 1973, AJC proposed TNM staging system for lung cancer Based on 2155 cases in Mountain s database at MDACC Expanded database used by Mountain to propose revisions through 1997 (5 th editions) No data to recommend changes for 6 th editions of staging manuals

6 LUNG CANCER STAGING IASLC* Staging Committee & Database Following 1997 staging system revision, IASLC decided to sponsor development of international database , IASLC database organized by Peter Goldstraw (thoracic surgeon, Brompton, UK) and John Crowley (CRAB, Seattle, USA) IASLC Staging Committee is international and multidisciplinary * = International Association for the Study of Lung Cancer

7 LUNG CANCER STAGING IASLC Database 100,869 cases treated between ,015 cases suitable for analysis (67,725 NSCLC, 13,290 SCLC, 513 carcinoid tumors) Evidence-based changes in T and M descriptors, maintenance of N descriptors Goldstraw et al. JTO 2007;2: ; multiple articles (Rami-Porta, Rusch, Postmus, Groome, Shepherd, Sculier, Travis) in JTO

8 NUMBERS OF CASES ANALYZED, by type of data source Registry 16,660 Series treated surgically 19,172 Clinical trial 24,239 Series treated by all 7866 modalities (incl surgery) Consortium 5912 Institutional registry 5492 Surgical registry 2154 TOTAL 81,495 Goldstraw et al. JTO 2006;1:

9 Goldstraw et al. JTO 2006;1:

10 Goldstraw et al. JTO 2006;1:

11 Rami-Porta et al. J Thorac Oncol 2007;2:

12 Survival by cn and pn for Surgically Managed Patients Rusch VW et al. J Thorac Oncol, 2007;2:

13 Survival by N Status and Number of Involved N Zones Rusch VW et al. J Thorac Oncol, 2007;2:

14 Goldstraw et al. J Thorac Oncol 2007;2:

15 Overall survival, expressed as a median survival time (MST) and 5-year survival, by clinical stage using the sixth edition of TNM (A) and proposed IASLC recommendations (B). Goldstraw et al. J Thorac Oncol 2007;2:

16 Overall survival, expressed as a median survival time (MST) and 5-year survival, by pathologic stage using sixth edition of TNM (A) and proposed IASLC recommendations (B) Goldstraw et al. J Thorac Oncol 2007; 2:

17 LUNG CANCER STAGING SYSTEM 7 th Edition: 2009 New staging system applies to: Non-small cell lung cancer Small cell lung cancer (replacing limited /extensive staging classification) Carcinoid tumors

18 Naruke vs. Mountain/Dresler Maps Comparison of Nomenclature Japanese Mountain / Dresler (ATS) Level 1 Levels 1 and 2 Levels 2, 3, 4R, 4L Levels 7 and 10 (subcarinal) Levels 4R and 4L Level 7 Rusch VW et al. J Thorac Oncol, 2007;2:

19 New IASLC Lymph Node Map Rusch & Asamura: JTO 2009; 4(5):

20 Developing / Revising Staging Systems Evidence for proposed revisions requires: international & multidisciplinary participation statisticians capable of managing and analyzing huge datasets Prospective data collection key to future revisions for all thoracic malignancies IASLC staging committee will now also address mesothelioma, esophageal Ca and possibly thymoma

21

22 Naruke Lymph Node Map Japan Lung Cancer Society, Tokyo: Kanehara & Co, 2000.

23 Mountain Dresler Lymph Node Map Chest, 1997;111: