Staging and Resectability in NSCLC

Assessing Stage According to the 8th Edition AJCC TNM Classification

The 8th edition AJCC TNM classification includes updated definitions for stage III NSCLC1

The latest edition of AJCC guidelines has refined the staging criteria to improve diagnostic and prognostic accuracy and help inform treatment decisions.2

Updates in the 8th edition AJCC TNM classification1,2

8th edition AJCC TNM classification updates
8th edition AJCC TNM classification updates

Stage IA was separated into IA1, IA2, and IA3.

T1N1 and T2aN1 tumors were upstaged from IIA to IIB.

T3N2 was upstaged from IIIA to IIIB.

T3N3 and T4N3 were upstaged from IIIB to the newly created IIIC.

Stage IV was separated into IVA and IVB.

Primary tumor (T) categories were updated in the 8th edition AJCC TNM classification

8th edition AJCC TNM classification tumor updates
8th edition AJCC TNM classification tumor updates

*Tis and T1mi were also added to define carcinoma in situ and minimally invasive adenocarcinoma, respectively.

Invades visceral pleura.

Invades parietal pleura, chest wall, phrenic nerve, or parietal pericardium.

§Invades diaphragm, mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, or carina.

Classifying regional nodal involvement (N) is a critical step in the staging process that can affect treatment, including resectability2,3

Definition of regional lymph nodes
Definition of regional lymph nodes

Nodal stations and their AJCC TNM classification

Nodal stations AJCC TNM classification
Nodal stations AJCC TNM classification

Nodal involvement (N) categories were not changed in the 8th edition AJCC TNM classification.1

In addition to clinical staging, pathologic staging is crucial for accurately assessing nodal involvement.3 Learn more.

Distant metastasis (M) categories have been expanded in the 8th edition AJCC TNM classification1

8th edition AJCC TNM classification distant metastasis updates
8th edition AJCC TNM classification distant metastasis updates

Accurate staging based on the latest guidelines is important for estimating prognosis and making treatment decisions for patients with NSCLC.2

AJCC, American Joint Committee on Cancer; NSCLC, non–small cell lung cancer.

References: 1. Rami-Porta R et al. CA Cancer J Clin. 2017;67(2):138-155. 2. Amin MB et al. AJCC Cancer Staging Manual. 8th ed. Springer; 2017. 3. Steinfort DP et al. Medicine (Baltimore). 2016;95(8):e2488. 4. Teran MD et al. J Thorac Dis. 2014;6(3):230-236.