The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: Proposals for the N and the M Components for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors.

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer 2024 Jan

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Stage classification is an important underpinning of management in patients with cancer and rests on a combination of three components-T for tumor extent, N for nodal involvement, and M for distant metastases. This article details the revision of the N and the M components of thymic epithelial tumors for the ninth edition of the TNM classification of malignant tumors proposed by the Thymic Domain of the International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee. The N and M components of the eighth edition staging system were verified by a large international collaborative data source through a data-driven analysis. A total of 9147 cases were included for analysis, including 7662 thymomas, 1345 thymic carcinomas, and 140 neuroendocrine thymic tumors. Lymph node involvement rates were 1.5% in thymomas and 17.6% and 27.7% in thymic carcinomas and neuroendocrine thymic tumors, respectively. Rates of lymph node metastasis were increasingly higher in tumors with higher T stage and higher-grade histologic type. Survival analysis validated the differences in the N and M categories proposed in the eighth edition staging system. Good discrimination in overall survival was detected among pathologic (p)N and pM categories in patients with thymoma and thymic carcinoma. No changes are proposed from the eighth edition for the N and M components. The proposed stage classification will provide a useful tool for management of the disease among the global thymic community. Copyright © 2023 International Association for the Study of Lung Cancer. All rights reserved.

Citation

Wentao Fang, Nicolas Girard, Vanessa Cilento, Emily Goren, Daniel Dibaba, Enrico Ruffini, Usman Ahmad, Sarit Appel, Andrea Bille, Souheil Boubia, Cecilia Brambilla, Ayten Kayi Cangir, Frank Detterbeck, Conrad Falkson, Pier Luigi Filosso, Giuseppe Giaccone, Francesco Guerrera, James Huang, Maurizio Infante, Dong Kwan Kim, Marco Lucchi, Mirella Marino, Edith M Marom, Andrew G Nicholson, Meinoshin Okumura, Ramon Rami-Porta, Andreas Rimner, Charles B Simone, Hisao Asamura, Members of the Staging and Prognostic Factors Committee, Members of the Advisory Boards and Participating Institutions of the Thymic Domain. The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: Proposals for the N and the M Components for the Forthcoming (Ninth) Edition of the TNM Classification of Malignant Tumors. Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 2024 Jan;19(1):52-70