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J. Pfannschmidt
“Neues von der IASLC -
Proposals zur 8ten Edition der
TNM Klassifikation für das
Lungenkarzinom“
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• •Immunhistochemie durchgängig zur Klassifizierung
• •Integration der molekularen Analyse
• •Neuklassifizierung fur kleine Biopsien bzw. Zytologie
• •Neuklassifizierung der pulmonalen Adenokarzinome
• •Neuklassifizierung der neuroendokrinen Tumoren
Journal of Thoracic Oncology, 2015, 10 (9),1243-1260
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Geschichte – TNM-Klassifizierung
• 1943 – 1952 Pierre Denoix Institute Gustave-Roussy
• UICC (Union internationale contre le cancer), Special committee on Clinical Stage Classification, 276 Mitgliedsorganisationen in 86 Ländern
• 1953 Publication of the "Uniform Technique for a Clinical Classification by the TNM System”
• 1968 Erstauflage TNM “pocket book” durch die UICC (TNM Prognostic Factors Project)
• 1987 Vereinigung der TNM Klassifikationen der UICC und AJCC (American Joint Committee for Cancer), 4te Edition
• 2010 7te Edition
• 2017 8te Edition
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Konsertierung
8th. Edition TNM (2017)
UICC + AJCC (2016)
Proposal: IASLC Staging and Prognostic Factors Committee (W. E.E. Eberhardt/Germany)
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EGFR-Mutation - Prävalenz
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IASLC Daten
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T-Deskriptor
Größe: cm ⬌ Prognose
Rami-Porta R, J Thoracic Oncol, 2015
International Association for the Study of Lung Cancer, 2015
Proposed (TNM 8th)
TNM 7th TNM 8th
≤1 cm: T1a T1a
>1-≤2 cm: T1a T1b
>2-≤3 cm: T1b T1c
>3-≤4 cm: T2a T2a
>4-≤5 cm: T2a T2b
>5-≤ 7 cm: T2b T3
>7 cm: T3 T4
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T-Deskriptor:
weitere Neuerungen
• Hauptbronchus:
- Abstand zur Karina < 2 cm: von T3 ➔ T2
• Atelektase/Pneumonie (endobronchialer Tumor):
- Totalatelektase/-Pneumonie: von T3 ➔ T2
• Zwerchfellinfiltration:
- von T3 ➔ T4
• Infiltration der mediastinalen Pleura:
- von T3 ➔ kein T Deskriptor
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T-Deskriptor:
Adenokarzinom
• AIS ➔ Tis (AIS) multiple AIS = multiple Primaries
• SCC in situ ➔ Tis (SCIS)
• MIA ➔ T1mi
• Radiologie, Größenbestimmung/längste Achse/1 mm SD-CT:
- Subsolide Rundherde (GGO/PSN) solider Anteil
- GGO < 0.5 cm AAH (atypische adenomatöse Hyperplasie) neben anderen DD
• Pathologie, Größenbestimmung:
- nicht schleimbildende AC: invasiver Anteil (nicht lepidisch)
- IMA (Staging wie andere invasive AC) mit lepidischen Anteil
Travis WD et al. JTO 2016; Vol. 11 No. 8: 1204-1223
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Radiologie
(A) Computed tomography scan shows a part solid nodule consisting mostly of a ground
glass nodule with a small solid component. (B) The longest diameter of the entire mass
is 2.1 cm (cT1c). (C) The longest diameter of the solid portion is 0.9 cm (cT1a).
Travis WD et al. JTO 2016;
Vol. 11 No. 8: 1204-1223
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“The mean percentages of consensual votes per pattern
ranged between 59.6 and 75 %, with lepidic and solid
being the pattern with the most discordant and concordant
votes, respectively. The other patterns ranged in between
(papillary 65.8 %; acinar 67.8 %; micropapillary 74.2 %). The
extent of disagreement decreased after the educational
session.”
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T-Deskriptor:
weitere Ergänzungen
• Multifokale GGO (histologisch lepidisches AC):
- T-Deskritor der höchsten Kategorie + Addendum m oder Anzahl
Z.b. T1b(3)N0M0 oder T1b(m)N0M0
- N-Deskriptor: gemeinsam
- Pneumonie-Typ AC:
Single-Lobe: T nach höchster Kategorie
Ipsilateral - multiple Lobe: T4
Contralateral Lobe: M1a
Detterbeck FC et al. JTO 2015
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T – Primary Tumour
Tx Primary tumour cannot be assessed
T0 No evidence of primary tumour
T1 Tumour 3 cm or less in greatest diameter surrounded by lung or visceral pleura, without
evidence of main bronchus
T1a(mi) Mininally invasive adenocarcinoma
T1a Tumour 1 cm or less in greatest diameter
T1b Tumour more than 1 cm but not more than 2 cm
T1c Tumour more than 2 cm but not more than 3 cm
T2 Tumour more than 3 cm but not more than 5 cm; or tumour with any of the following features:
Involves main bronchus (without involving the carina), invades visceral pleura, associated with
atelectasis or obstructive pneumonitis that extends to the hilar region
T2a Tumour more than 3 cm but not more than 4 cm
T2b Tumour more than 4 cm but not more than 5 cm
T3 Tumour more than 5 cm but not more than 7 cm or one tha directly invades any of the following:
chest wall, phrenic nerve, parietal pericardium, or associated separate tumour nodule(s) in the
same lobe as the primary
T4 Tumours more than 7 cm or one that invades any of the following: diaphragm, mediastinum,
heart, great vessels, trachea, recurrent laryngeal nerve, oesophagus, vertebral body, carina;
separate tumour nodule(s) in a different ipsilateral lobe to that of the primary
International Association for the Study of Lung Cancer, 2015
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N-Deskriptor
• Keine Veränderung
• Empfehlungscharakter zur Dokumentaton:
- N1
N1a: single Station N1
N1b: multiple station N1
- N2
N2a1: single station N2 ohne N1 (“skip” Metastase)
N2a2: single station N2 mit N1
N2b: multiple station N2
Asamura H et al. J Thorac Oncol. 2015;10: 1675–1684
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N – Regional Lymph Nodes
Nx Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph
nodes and intrapulmonary nodes, including involvement by direct
extension
N2 Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3 Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral
or contralateral scalene or supraclavicular lymph node(s)
International Association for the Study of Lung Cancer, 2015
N-Deskriptor
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M-Deskriptor
M – Distant Metastasis
M0 No distant metastasis
M1 Distant metastasis
M1a Separate tumour nodule(s) in a contralateral lobe; tumour with
pleaural or pericardial nodules or malignant pleural or pericardial
effusion
M1b Single extrathoracic metastasis in a single organ
M1c Multiple extrathoracic metastases in one or several organs
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M-Deskriptor:
M1c
“ it is recommended to prospectively register in
Detail
(a) the number of metastatic lesions and
(b) the number of involved organs.”
Eberhardt WEE et al. J Thorac Oncol. 2015;10: 1515–1522)
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M-Deskriptor
Proposed Category
(8th. Edition)
Variable (7th. Editon)
M1a Stage IVa M1a
M1b M1b (single organ lesion,
extrathorakal)
M1c Stage IVb M1b (single organ,
extrathorakal/multiple lesions)
M1b (multiple organs)
J Thorac Oncol. 2015;10: 1515–1522
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Proposed 8th Edition
J Thorac Oncol. 2015;10: 1515–1522
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M-Deskriptor
Martini-Melamed Kriterien in Diskussion
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SCLC
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STAGE T N M
Occult TX N0 M0
0 Tis N0 M0
IA1 T1a(mi)/T1a N0 M0
IA2 T1b N0 M0
IA3 T1c N0 M0
IB T2a N0 M0
IIA T2b N0 M0
IIB T1a-T2b N1 M0
T3 N0 M0
IIIA T1a-T2b N2 M0
T3 N1 M0
T4 N0/N1 M0
IIIB T1a-T2b N3 M0
T3/T4 N2 M0
IIIC T3/T4 N3 M0
IVA Any T Any N M1a/M1b
IVB Any T Any N M1c
International Association for the Study of Lung Cancer, 2015
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STAGE T N M
Occult TX N0 M0
0 Tis N0 M0
IA1 T1a(mi)/T1a N0 M0
IA2 T1b N0 M0
IA3 T1c N0 M0
IB T2a N0 M0
IIA T2b N0 M0
IIB T1a-T2b N1 M0
T3 N0 M0
IIIA T1a-T2b N2 M0
T3 N1 M0
T4 N0/N1 M0
IIIB T1a-T2b N3 M0
T3/T4 N2 M0
IIIC T3/T4 N3 M0
IVA Any T Any N M1a/M1b
IVB Any T Any N M1c
International Association for the Study of Lung Cancer, 2015
NEW
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N0 N1 N2 N3 M1
a
M1
b
M1
c
T1a IA1 IIB IIIA IIIB IVA IVA IVB
T1b IA2 IIB IIIA IIIB IVA IVA IVB
T1c IA3 IIB IIIA IIIB IVA IVA IVB
T2a IB IIB IIIA IIIB IVA IVA IVB
T2b IIA IIB IIIA IIIB IVA IVA IVB
T3 IIB IIIA IIIB IIIC IVA IVA IVB
T4 IIIA IIIA IIIB IIIC IVA IVA IVB
International Association for the Study of Lung Cancer, 2015
8th Edition of the TNM Classification for Lung Cancer
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Ausblick
Bremnes RM et al. JTO Vol. 11 No. 6: 789-800
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32 Travis WD et al. JTO 2016; Vol. 11 No. 8: 1204-1223
