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Ellen Caroline Toledo Nascimento
MS11 - Addressing Challenges with Surgical Resection of Lung Cancer (ID 74)
- Event: WCLC 2019
- Type: Mini Symposium
- Track: Treatment in the Real World - Support, Survivorship, Systems Research
- Presentations: 1
- Now Available
MS11.05 - Pathological Reporting of Resected Lung Cancer - the Importance of Using Additional TNM Descriptors (Now Available) (ID 3504)
15:45 - 17:30 | Presenting Author(s): Ellen Caroline Toledo Nascimento
Context. The anatomopathological examination aims to establish a specific diagnosis of the tumor and to provide essential information related to cancer staging, patient management and prognosis. Such information, as histologic type, lymphovascular invasion, spread through air spaces, margins, treatment effect, and TNM descriptors should be disclosed concisely, following previously defined protocols, and correlate satisfactorily with radiological exams and clinical aspects in order to allow the best management for the patient.
Histopathological (macroscopic and microscopic evaluation) combined with complementary immunohistochemical and molecular studies, provides prognostic and predictive information on tumor biology and clinical behavior. The TNM staging classifies the tumors according to the anatomic extent with an important prognostic impact. In addition, it allows the establishment of criteria for inclusion and exclusion of patients in protocol studies and subgroups of treatment, cancer registry, epidemiology and multidisciplinary management.
The T component analysis is complex because it has many elements: presence or absence of invasion, tumor size, endobronchial location, atelectasis / pneumonitis and invasion of the various anatomical structures around the lung. The determination of the largest tumor diameter requires accurate measurements since in the eighth edition TNM stage classification for lung cancer each centimeter separates tumors with different prognoses from 1 to 5 centimeters (cm). Appropriate size measurement is especially important when it comes to subsolid tumors since the correlation with the computed tomographic imaging in this context is of great value. Tumors measuring larger than 5 cm up to 7 cm (T3 in the eighth edition) had a worse prognosis than found in the seventh edition of the TNM classification. Tumors larger than 7 cm (T4 in the eighth edition) have similar prognosis to other descriptors in the T4 category. Atelectasis or pneumonitis involving the whole lung (T3 in the seventh edition) has the same prognosis for partial atelectasis / pneumonitis (T2 descriptor in the seventh edition). Endobronchial tumor location less than 2 cm from carina (a T3 descriptor in the seventh edition), but without carina involvement, had the same prognosis as the endobronchial location further than 2 cm from carina (a T2 descriptor in the seventh edition). In the eighth edition, tumors involving the main bronchus and associated with atelectasis / pneumonitis are classified as T2. On the other hand, diaphragm invasion (a T3 descriptor in the seventh edition was upstaged to T4 in the eighth edition) since it has similar prognosis of T4 tumors.
No changes to the N descriptors were proposed in the 8th TNM as the four N categories (N0, N1, N2, N3). The reassessment of the M component validated the proposed M1a category descriptors in the seventh edition and separated the distant metastases into two categories with different prognoses, M1b (single metastatic tumor in one organ), and M1c (multiple metastases in either single organ or multiple organs).
Objective. To review and discuss the 8th edition of the TNM classification of lung cancer with an emphasis on prognostic relevance and implications for the pathologist's report.
Data Sources. The review is based on the available literature.
Conclusion. The TNM (tumor-node-metastasis) classification system for lung cancer is the strongest prognostic indicator and fundamental for decisions on therapy. The eighth edition of the TNM classification of lung cancer enhances the prognostic discrimination of the different T categories and differentiates unique extrathoracic metastasis (better prognosis) from multiple metastases in one or several organs providing better definition of oligometastatic disease. Thus, the eighth edition of TNM improves the understanding of tumor anatomic extent and stratification of tumors for clinical trials.
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