Abstract
The status of lymph node involvement is a major component of the TNM staging system.
The N categories for lung cancer have remained unchanged since the fourth edition
of the TNM staging system, partly because of differences in nodal mapping nomenclature,
partly because of insufficient details to verify possible alternative approaches for
staging. In preparation for the rigorous analysis of the International Association
for the Study of Lung Cancer database necessary for the ninth edition TNM staging
system, members of the N-Descriptors Subcommittee of the International Association
for the Study of Lung Cancer Staging and Prognostic Factors Committee reviewed the
evidence for alternative approaches to categorizing the extent of lymph node involvement
with lung cancer, which is currently based solely on the anatomical location of lymph
node metastasis. We reviewed the literature focusing on NSCLC to stimulate dialogue
and mutual understanding among subcommittee members engaged in developing the ninth
edition TNM staging system for lung cancer, which has been proposed for adoption by
the American Joint Committee on Cancer and Union for International Cancer Control
in 2024. The discussion of the range of possible revision options for the N categories,
including the pros and cons of counting lymph nodes, lymph node stations, or lymph
node zones, also provides transparency to the process, explaining why certain options
may be discarded, others deferred for future consideration. Finally, we provide a
preliminary discussion of the future directions that the N-Descriptors Subcommittee
might consider for the 10th edition and beyond.
Keywords
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Article info
Publication history
Published online: December 23, 2022
Accepted:
December 16,
2022
Received in revised form:
December 12,
2022
Received:
November 5,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Disclosure: Dr. Osarogiagbon reports paid consultant from American Cancer Society, Biodesix, Association of Community Cancer Centers, Genentech/Roche, Lungevity Foundation, National Cancer Institute, Tryptych Healthcare Partners and Honoraria for lectures fromAstraZeneca. Patent issued: Lymph node specimen collection kit and method. Fiduciary Board: Hope Foundation for Cancer Research (SWOG). Scientific Advisory Board: National Lung Cancer Round Table, Lung Cancer Foundation of America, GO2 Foundation, Druckenmiller Center for Lung Cancer Research at Memorial Sloan Kettering Cancer Center, LUNGevity Foundation, National Cancer Institute. Stock ownership: Eli Lilly, Gilead Sciences, Pfizer. Founder: Founder, Oncobox Devices, Inc. The remaining authors declare no conflict of interest.
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© 2022 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.
