title: The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the Clinical and Pathologic Staging of Small Cell Lung Cancer in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer.
abstract: BACKGROUND
  Small cell lung cancer (SCLC) is commonly classified as either limited or extensive, but the Union for International Cancer Control TNM Classification of Malignant Tumours seventh edition (2009) recommended tumor, node, and metastasis (TNM) staging based on analysis of the International Association for the Study of Lung Cancer (IASLC) database.
  
  
  METHODS
  Survival analyses were performed for clinically and pathologically staged patients presenting with SCLC from 1999 through 2010. Prognosis was compared in relation to the TNM seventh edition staging to serve as validation and analyzed in relation to proposed changes to the T descriptors found in the eighth edition.
  
  
  RESULTS
  There were 5002 patients: 4848 patients with clinical and 582 with pathological stages. Among these, 428 had both. Survival differences were confirmed for T and N categories and maintained in relation to proposed revisions to T descriptors for seventh edition TNM categories and proposed changes in the eighth edition. There were also survival differences, notably at 12 months, in patients with brain-only single-site metastasis (SSM) compared to SSM at other sites, and SSM without a pleural effusion showed a better prognosis than other patients in the M1b category.
  
  
  CONCLUSIONS
  We confirm the prognostic value of clinical and pathological TNM staging in patients with SCLC, and recommend continued usage for SCLC in relation to proposed changes to T, N, and M descriptors for NSCLC in the eighth edition. However, for M descriptors, it remains uncertain whether survival differences in patients with SSM in the brain simply reflect better treatment options rather than better survival based on anatomic extent of disease.
authors.affiliation: Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK. Electronic address: a.nicholson@rbht.nhs.uk.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Nicholson
authors.affiliation: Cancer Research and Biostatistics, Seattle, WA, USA.
authors.forename: Kari
authors.initials: K
authors.lastname: Chansky
authors.affiliation: Cancer Research and Biostatistics, Seattle, WA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Crowley
authors.affiliation: Department of Thoracic Surgery, University of São Paulo, São Paulo, Brazil.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Beyruti
authors.affiliation: Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Department of Radiotherapy, Sinai Grace Hospital, Detroit, MI, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Turrisi
authors.affiliation: Department of Medical Oncology, West German Cancer Centre, Ruhrlandklinik, University Hospital Essen, University Duisburg-Essen, Germany.
authors.forename: Wilfried E E
authors.initials: WE
authors.lastname: Eberhardt
authors.affiliation: Department of Oncology, Antwerp University Hospital, Edegem (Antwerp), Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: van Meerbeeck
authors.affiliation: Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa and CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rami-Porta
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000145:classification* / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D055752:Small Cell Lung Carcinoma / Q000145:classification* / Q000473:pathology*; D016019:Survival Analysis
keywords: Lung cancer; Lung cancer staging; Small cell lung cancer; TNM classification