title: Clinical relevance of the M1b and M1c descriptors from the proposed TNM 8 classification of lung cancer.
abstract: OBJECTIVE
  The TNM 8 lung cancer staging system reclassifies patients with a solitary extrathoracic metastasis as M1b and two or more extrathoracic metastases as M1c. This study investigates the clinical relevance of this change.
  
  
  METHODS
  Advanced lung cancer patients were retrospectively restaged according to the TNM8 M1b and M1c classifiers. Overall survival was compared in M1b and M1c patients staged with and without PET-CT. We then summarized the TNM 8 staging classification and the relevant literature on the treatment of oligometastatic lung cancer.
  
  
  RESULTS
  In all, 82 patients with metastatic lung cancer were reclassified according to the TNM 8: 14 had M1b and 58 had M1c disease. Those with M1b disease lived significantly longer than those with M1c disease (15.2 vs. 7.3 months, p = 0.0029). Among those with M1b disease, survival was the highest when M1b status was confirmed by PET-CT (21.4 vs. 7 months). M1c patients with 4 or less distant metastases had a trend to longer survival vs. M1c patients with 5 or more metastases (9.4 vs. 7.3 months), especially when PET-CT staging was used (13.9 months).
  
  
  CONCLUSIONS
  We confirmed the prognostic value of the M1b and M1c descriptors in a Western European tertiary care population. The use of PET-CT seems to increase the prognostic value of the M descriptor and may define an additional oligometastatic subgroup of M1c patients. Clinical trials investigating the treatment of patients with varying degrees of metastatic disease are needed and should be based on PET-CT staging.
authors.affiliation: Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University Munich, Ziemssenstraße 1, 80336, Munich, Germany. amanda.tufman@med.uni-muenchen.de.|Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany. amanda.tufman@med.uni-muenchen.de.
authors.forename: Amanda
authors.initials: A
authors.lastname: Tufman
authors.affiliation: Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.|Department of Radiology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: Kathrin
authors.initials: K
authors.lastname: Kahnert
authors.affiliation: Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University Munich, Ziemssenstraße 1, 80336, Munich, Germany.|Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.
authors.forename: Diego
authors.initials: D
authors.lastname: Kauffmann-Guerrero
authors.affiliation: Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.|Department of Radiation Oncology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: Farkhad
authors.initials: F
authors.lastname: Manapov
authors.affiliation: Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University Munich, Ziemssenstraße 1, 80336, Munich, Germany.|Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Milger
authors.affiliation: Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.|Department of Radiology, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Müller-Lisse
authors.affiliation: Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.|Department of Thoracic Surgery, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: Hauke
authors.initials: H
authors.lastname: Winter
authors.affiliation: Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University Munich, Ziemssenstraße 1, 80336, Munich, Germany.|Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.
authors.forename: Rudolf Maria
authors.initials: RM
authors.lastname: Huber
authors.affiliation: Member of the German Centre for Lung Research (DZL CPC-M), Munich, Germany.|Department of Thoracic Surgery, Ludwig-Maximilians University Munich, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schneider
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D038622:Internationality; D008175:Lung Neoplasms / Q000145:classification / Q000401:mortality* / Q000473:pathology*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000592:standards*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
keywords: Lung cancer; Metastasis; Oligometastatic; Stage IV; Staging