A Radiologic Review of the New TNM Classification for Lung Cancer -- Kligerman and Abbott 194 (3): 562 -- American Journal of Roentgenology

A Radiologic Review of the New TNM Classification for Lung Cancer -- Kligerman and Abbott 194 (3): 562 -- American Journal of Roentgenology

TABLE 1: Seventh Edition of the TNM Classification of Lung Cancer Compared With the Sixth Edition

Tumor Designation Prior System (Sixth Edition) New System (Seventh Edition) Five-Year Survival Rate (%) Size 2 cm T1 T1aa 77d >2 but 3 cm T1 T1ba 71d > 3 but 5 cm T2 T2aa 58d > 5 but 7 cm T2 T2ba 49d > 7 cm T2 T3a 35d Pleural or pericardial invasion Visceral pleura T2 T2ab or T2bc NAe Parietal pleura T3 T3 NAe Mediastinal pleura T3 T3 NAe Parietal pericardium T3 T3 NAe Central airway invasion Tumor extending into mainstem bronchus > 2 cm from carina T2 T2ab or T2bc NAe Tumor extending into mainstem bronchus 2 cm from carina T3 T3 NAe Tumor extending to carina T4 T4 NAe Lung atelectasis Tumor causing atelectasis of less than entire lung T2 T2ab or T2bc NAe Tumor causing atelectasis of entire lung T3 T3 NAe Soft tissue invasion Chest wall and superior sulcus T3 T3 NAe Diaphragm T3 T3 NAe Mediastinum T4 T4 NAe Heart or great vessels T4 T4 NAe Trachea T4 T4 NAe Esophagus T4 T4 NAe Osseous invasion Rib T3 T3 NAe Vertebral body T4 T4 NAe Nerve invasion Phrenic nerve T3 T3 NAe Recurrent laryngeal nerve T4 T4 NAe Satellite nodules Same lobe T4 T3 28f Same lung, different lobe M1 T4 22f Lymph node designation No lymphadenopathy N0 N0 56g Ipsilateral, peripheral, or hilar—interlobar zone involvement N1 N1 38g Ipsilateral upper, aorticopulmonary, lower, or subcarinal zone involvement N2 N2 22g Supraclavicular or contralateral upper, aorticopulmonary, lower, hilar—interlobar, or peripheral zone involvement N3 N3 6g Metastatic disease designation Contralateral lung metastases M1 M1a 3h Pleural or pericardial dissemination T4 M1a 2h Distant metastases M1 M1b 1h

Note—Cells in bold indicate a change in the designation from the sixth edition. NA indicates not applicable.

^a T designation is listed for tumors completely surrounded by lung. Designation can increase depending on presence and extent of invasion.

^b T 2a designation if tumor measures 5 cm in long-axis diameter.

^c T 2b designation if tumor measures > 5 cm but 7 cm in long-axis diameter.

^d Survival based on patients staged pathologically with complete resection of tumor (R0) and no nodal or extranodal metastatic disease (N0M0).

^e Individual survival statistics not calculated due to limited information. As a group, 5-year survival rate in patients pathologically staged with a T3 and T4 designation (excluding those with tumors > 7 cm or satellite nodules), any R, any N, and M0 was 31% and 22%, respectively.

^f Survival based on patients staged pathologically with complete or incomplete resection of tumor (any R), any nodal disease (any N), and M0.

^g Survival based on patients staged pathologically with any tumor designation (any T) and M0.

^h Survival based on patients staged clinically with any T and any N.