ORIGINAL ARTICLE

The International Association for the Study of Lung

Cancer Lung Cancer Staging Project: Proposals for
the Revisions of the T-Descriptors in the
Forthcoming Ninth Edition of the TNM
Classification for Lung Cancer
Paul E. Van Schil, MD, PhD,a,* Hisao Asamura, MD, PhD,b
Katherine K. Nishimura, PhD, MPH,c Ramon Rami-Porta, MD, PhD,d,e
Young Tae Kim, MD, PhD,f Pietro Bertoglio, MD,g Ayten K. Cangir, MD,h
Jessica Donington, MD,i Wentao Fang, MD,j Dorothy J. Giroux, MS,c
Yolande Lievens, MD, PhD,k Hui Liu, MD,l Gustavo Lyons, MD,m Shuji Sakai, MD,n
William D. Travis, MD, PhD,o Paula Ugalde, MD,p Chi-Fu Jeffrey Yang, MD,q
Masaya Yotsukura, MD,r Frank Detterbeck, MD,s and the
Members of the International Association for the Study of Lung Cancer Staging and
Prognostic Factors Committee, Advisory Boards and Participating Institutions**
a
Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
b
Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
c
Cancer Research And Biostatistics, Seattle, Washington
d
Department of Thoracic Surgery, Hospital Universitari Mútua Terrassa, University of Barcelona
e
CIBERES Lung Cancer Group, Terrassa, Barcelona, Spain
f
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College
of Medicine, Seoul, Republic of Korea
g
Division of Thoracic Surgery, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
h
Faculty of Medicine, Ankara University, Ankara, Turkey
i
Department of Surgery, University of Chicago, Chicago, Illinois
j
Department of Thoracic Surgery, Shanghai Chest Hospital, Jiaotong University Medical School, Shanghai, People’s Republic
of China
k
Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
l
Sun Yat-Sen University Cancer Center, Guangdong Sheng, People’s Republic of China
m
Thoracic Surgery Department, Buenos Aires British Hospital, Buenos Aires, Argentina
n
Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women’s Medical University, Tokyo, Japan
o
Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
p
Department of Thoracic Surgery, Brigham & Women’s Hospital, Boston, Massachusetts
q
Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Massachusetts
r
Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
s
Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut

Received 30 October 2023; revised 21 November 2023; accepted 3 December 2023

Available online - 7 December 2023

Grant: p30 CA008748). Dr. Ugalde reports receiving honoraria from

*Corresponding author.
**See Appendices 1 to 3.
Disclosure: Dr. Van Schil reports receiving consulting fees from
AstraZeneca, Bristol-Myers Squibb, Merck Sharp & Dohme, Roche, and
Janssen; honoraria from AstraZeneca, Bristol-Myers Squibb, Merck
Sharp & Dohme, Roche, and Janssen; and has leadership positions at
the International Association for the Study of Lung Cancer (IASLC) and
Belgian Association for Cardio-Thoracic Surgery (BACTS). Dr. Kim re-
ports honoraria from AstraZeneca and Roche. Dr. Lievens reports
receiving grants and contracts from the ImmunoSABR EU Project and
HERO-VBHC; and consulting fees from AstraZeneca. Drs. Liu, Lyons,
Sakai, and Travis report receiving grants from the National Cancer
Institute (NCI) (Memorial Sloan Kettering Cancer Center [MSKCC] Core
AstraZeneca, Merck Sharp & Dohme, Bristol-Myers Squibb, Medtronic,
and Johnson & Johnson. Dr. Yang reports receiving honoraria from
AstraZeneca. The remaining authors declare no conflict of interest.
Address for correspondence: Paul E. Van Schil, MD, PhD, Department of
Thoracic and Vascular Surgery, Antwerp University Hospital and Ant-
werp University, Drie Eikenstraat 655, 2650 Edegem (Antwerp),
Belgium. E-mail: paul.van.schil@uza.be
ª 2023 International Association for the Study of Lung Cancer.
Published by Elsevier Inc. All rights reserved.
ISSN: 1556-0864
https://doi.org/10.1016/j.jtho.2023.12.006

Journal of Thoracic Oncology Vol. 19 No. 5: 749–765

750 Van Schil et al
ABSTRACT
Introduction: An international database was created by the
International Association for the Study of Lung Cancer to
inform on the ninth edition of the TNM classification of lung
cancer. The present analyses concern its T component.
Methods: Data on 124,581 patients diagnosed with lung
cancer from January 1, 2011 to December 31, 2019 were
submitted to the International Association for the Study of
Lung Cancer database. Of these, 33,982 met the inclusion
criteria for the clinical T analysis, and 30,715 met the in-
clusion criteria for the pathologic postsurgical analysis.
Survival was measured from the date of diagnosis or
operation for clinically and pathologically staged tumors,
respectively. T descriptors were evaluated in univariate
analysis and multivariable Cox regression analysis adjusted
for age, sex, pathologic type, and geographic region.
Results: Comprehensive survival analysis revealed that the
existing eighth edition T component criteria performed
adequately in the ninth edition data set. Although pathologic
chest wall or parietal pleura involvement (PL 3) yielded a
worse survival compared with the other T3 descriptors,
with a similar survival as T4 tumors, this difference was not
observed for clinical chest wall or PL 3 tumors. Because of
these inconsistent findings, no reallocation of chest wall or
PL 3 tumors is advised.
Conclusions: The T subcommittee members proposed not
to implement any changes and keep the current eighth-
edition T descriptors for the ninth edition.
 2023 International Association for the Study of Lung
Cancer. Published by Elsevier Inc. All rights reserved.
Keywords: Lung cancer; Lung cancer staging; T-component;
T-descriptors; TNM classification
Introduction
In the eighth edition of the TNM classification of lung
cancer published in 2015, profound changes were made
concerning the T descriptors.1 A diameter of 3 cm was
kept to distinguish T1 from T2 tumors. Size was found to
be an important prognostic factor. Increments of 1 cm
were implemented until 5 cm, resulting in the following
subdivisions: T1a (
1 cm), T1b (> 1 cm and
2 cm),
T1c (>2 cm and
3 cm), T2a (>3 cm and
4 cm), T2b
(>4 cm and
5 cm). Tumors greater than 5 cm and less
than 7 cm were reclassified as T3, and tumors greater
than 7 cm as T4. Involvement of the main bronchus was
defined as a T2 descriptor regardless of the distance
from the carina. Partial and total atelectasis or pneu-
monitis were also grouped as T2 descriptors. Diaphrag-
matic invasion was reclassified as T4 and mediastinal
pleura invasion was deleted as a T descriptor. Further-
more, for part-solid lesions, only the solid or invasive
Journal of Thoracic Oncology Vol. 19 No. 5
part was recommended to determine the T size.2 An
overview of the eighth edition T classification is pro-
vided in Supplementary Table 1.
After the publication of the eighth edition of the TNM
classification, the International Association for the Study of
Lung Cancer (IASLC) launched the third phase of the In-
ternational Staging Project in 2018.3 To update and refine
the TNM classification, a new database was created for
cases diagnosed between 2011 and 2019, with follow-up
data until the end of December 2021.4 This database was
used to inform the ninth edition of the TNM classification.
The present article summarizes the results of the an-
alyses of the new IASLC database performed by the
members of the T subcommittee of the IASLC Staging and
Prognostic Factors Committee and the statisticians of
Cancer Research And Biostatistics (CRAB) concerning the
T component of the TNM classification and its descriptors.
The analyses were conducted to achieve the following
predefined objectives: (1) to validate the descriptors of
the eighth classification using the database for the ninth
edition; (2) to assess whether further adaptations to the T
descriptors were necessary; and (3) to specifically assess
the prognostic impact of chest wall or parietal pleura (PL
3) invasion and determine whether reallocation of such
tumors is warranted on the basis of patient outcomes.5 To
this end, specific methods and guiding principles for the
development of the ninth edition were developed.6
Materials and Methods
Population
A total of 124,581 cases were submitted to the ninth
edition staging project (Supplementary Fig. 1). Of those,
73,197 satisfied the general inclusion criteria including
valid pathologic type, survival time, diagnosis date be-
tween 2011 and 2019, valid stage, and NSCLC. One large
registry data set with patients diagnosed in 2010
(outside of the prespecified time window) was included
in the analysis given the substantial sample size and high
quality of the data, and one site was excluded from the
final analysis owing to concerns about aberrant patterns
of correlation between clinical and pathologic N-category
information. Of the included patients, 33,982 and 30,715
met the inclusion criteria for evaluation of the clinical T
component (cT) and pathologic T component (pT) ana-
lyses, respectively. To further inform the T-stage anal-
ysis, data on the solid (clinical) or invasive (pathologic)
size was sought for all analyses. However, characteristics
of the submitted data left some uncertainty as to how
size was determined in some cases, likely because of the
fact that the focus on solid/invasive size for staging
purposes was not published until 2016 and the time it
takes for awareness and for local data collection systems
to adapt.2 Despite attempts to be as specific as possible,
May 2024
it proved difficult to identify with certainty the cases
involving only solid/invasive size or to precisely define
the proportion of such cases among all submitted cases.
However, it seems that the issue mainly pertains to the
T1 category; for T2 to T4, the proportion of cases in
which an uncertain size measurement determined the T
category is estimated to be less than 5%. Furthermore,
approximately 5000 cases involving uncertainty
regarding the nature of the size measurement involved a
2010 cohort from Japan; analyses with and without
these cases did not meaningfully change the presence of
or magnitude of differences between T categories and
subcategories. Finally, among T1 subcategories, in which
the issue of solid/invasive versus total size is likely to
play the largest role, a subset analysis involving only
nonmucinous adenocarcinoma cases with invasive size
recorded and diagnosed in 2018 or later revealed step-
wise progressively worse overall survival (OS) with
increasing T1 subcategories (although the sample size
limited the feasibility of statistical comparisons).
Therefore, a more inclusive approach was chosen for the
analyses and figures in this article, involving largely
cases submitted with an invasive size measurement but
with a proportion in whom the size measurement was
uncertain, or likely represented total size. A valid N
component, as well as M0 status, were also required, in
addition to passing general quality control screens.
When analyzing the data on visceral pleural invasion,
which is a T2 descriptor, for some centers, a discrepancy
was noted between visceral pleural invasion and pleural
status (PL). To correct this issue, a cleaning step was
introduced by CRAB to correct for visceral pleural in-
vasion status for one site, which provided corrected data
to support this cleaning step.
The number of cases and patients’ characteristics are
presented in Table 1 and Supplementary Table 2). Of
clinical stage cases, 31,329 were managed surgically, and
2350 were managed nonsurgically (Supplementary
Table 2). Among those with pathologic N0 tumors,
21,484 patients who did not receive neoadjuvant treat-
ment were available for the main pT analysis, and 804
patients were treated with neoadjuvant therapy and
further analyzed.
A total of 43% of all clinical T patients were younger
than 65 years, and 53% of all pathologic T patients were
65 years or older (Table 1).
Regarding specific type, 76% of patients had NSCLC
with nonsquamous and nonneuroendocrine pathology in
the cT and pT subgroups (Supplementary Fig. 2, Table 1,
and Supplementary Table 3). Adenocarcinoma was the
most frequent pathologic type, found in 70% and 72% of
cT and pT tumors, respectively.
Most of the included patients came from Asia (66%
cT, 64% pT). Most patients had N0 tumors (82% cT,
Revisions T-Descriptors 9th Edition TNM 751
74% pT). Surgical treatment was provided in 93% of all
patients with clinically staged tumors.
For patients with pT tumors, complete R0 resection
was achieved in 94%, R1 or R2 resection in 3%, and the
R descriptor was unknown in 3%.
Statistical Analysis
The primary end point was OS, which was measured
from the date of diagnosis for patients with clinically staged
tumors and the date of operation for those with patholog-
ically staged cancers. After screening for eligibility and data
completeness, survival between T categories was explored
graphically using the Kaplan-Meier method.7 Pairwise dif-
ferences in survival between adjacent T categories were
tested using the log-rank test.8 Reproducibility of findings
was further assessed in subgroup analyses including N-
component subgroups, pathologic type, region, diagnosis
year, and treatment with neoadjuvant therapy. Prognostic
groups were assessed using multivariable Cox proportional
hazards regression analysis stratified by data source with a
distinction between electronic data capturing (EDC) and
batch data sets.9 Adjustments were made for age (<65
versus 65 years), sex (male versus female sex), pathologic
type (squamous versus nonsquamous), and geographic
region (Europe, North America, or Rest of World [ROW]
versus Asia). All survival and regression analyses were
performed using the Statistical Analysis System version 9.4
(SAS Institute, Cary, NC) or R software (R Foundation for
Statistical Computing, Vienna, Austria).
T descriptors were analyzed separately among T1,
T2, T3, and T4 to verify that all T descriptors within the
same category had similar survival. Kaplan-Meier curves
were used to visualize clinical and pathologic T de-
scriptors, comparing survival patterns of T descriptors
within a category, and to the T-category one level higher
and lower. Any T descriptor with fewer than 50 cases
was collapsed into the “other single descriptor” category
on the basis of the recommendation that it is question-
able to include descriptors in the definition of stage
classification that are reported in less than 50 cases as,
generally, there are too few events to permit a robust
survival analysis.6 If more than one T descriptor was
reported, the patient was included in a “multiple de-
scriptors” category. Descriptors identified for potential
reclassification, on the basis of their respective survival
outcome compared with other descriptors in the same or
adjacent category, were then evaluated in a multivariate
Cox regression analysis stratified by data source and
adjusted for age, sex, pathologic type, and geographic
region. Specific comparisons were made between the
survival of patients with a given descriptor against other
cases within its category as defined by the eighth edition
and against those in the proposed category. If a given
descriptor was significantly different from others in the
752 Van Schil et al Journal of Thoracic Oncology Vol. 19 No. 5

Table 1. Patient Characteristics

All cT cT1 cT2 cT3 cT4

Specific item n (%) n (%) n (%) n (%) n (%)

Grand total 33,982 (100) 18,765 (100) 8941 (100) 3681 (100) 2595 (100)
Region, n (%)
Asia 22,513 (66) 13,385 (71) 5946 (67) 1938 (53) 1244 (48)
Europe 4175 (12) 1564 (8) 1168 (13) 779 (21) 664 (26)
North America 6324 (19) 3396 (18) 1576 (18) 812 (22) 540 (21)
Rest of the World 970 (3) 420 (2) 251 (3) 152 (4) 147 (6)
GDP, n (%)
Low 11,271 (33) 6423 (34) 2955 (33) 1053 (29) 840 (32)
Mid 14,363 (42) 8307 (44) 3928 (44) 1347 (37) 781 (30)
High 8348 (25) 4035 (22) 2058 (23) 1281 (35) 974 (38)
Sex, n (%)
Male 16,231 (48) 8288 (44) 4397 (49) 1972 (54) 1574 (61)
Female 17,749 (52) 10,475 (56) 4551 (51) 1709 (46) 1021 (39)
No data 2 (0) 2 (0) . . . . . .
Age, n (%)
<65 y 14,728 (43) 8311 (44) 3642 (41) 1511 (41) 1264 (49)
65 y 19,188 (56) 10,413 (55) 5281 (59) 2166 (59) 1328 (51)
No data 66 (0) 41 (0) 18 (0) 4 (0) 3 (0)
NSCLC histology, n (%)
AIS 444 (1) 377 (2) 38 (0) 15 (0) 14 (1)
Adenocarcinoma 23,954 (70) 15,269 (81) 5599 (63) 1880 (51) 1206 (46)
Adenosquamous 657 (2) 245 (1) 253 (3) 105 (3) 54 (2)
Large cell 425 (1) 130 (1) 126 (1) 93 (3) 76 (3)
NSCLC NOS 347 (1) 52 (0) 99 (1) 79 (2) 117 (5)
Squamous 8155 (24) 2692 (14) 2826 (32) 1509 (41) 1128 (43)
Resection, n (%)
Nonsurgical 2350 (7) 393 (2) 525 (6) 528 (14) 904 (35)
Surgical R0 29,305 (86) 17,525 (93) 7650 (86) 2762 (75) 1368 (53)
Surgical R1 or R2 1099 (3) 379 (2) 361 (4) 214 (6) 145 (6)
Surgical R unknown 925 (3) 330 (2) 333 (4) 139 (4) 123 (5)
Surgical status unknown 303 (1) 138 (1) 72 (1) 38 (1) 55 (2)
N-component, n (%)
N0 27,971 (82) 17,507 (93) 6936 (78) 2315 (63) 1213 (47)
N1 2358 (7) 593 (3) 886 (10) 543 (15) 336 (13)
N2 2838 (8) 577 (3) 923 (10) 646 (18) 692 (27)
N3 815 (2) 88 (0) 196 (2) 177 (5) 354 (14)
All pT pT1 pT2 pT3 pT4

Specific item n (%) n (%) n (%) n (%) n (%)

Grand total 28,934 (100) 10,725 (100) 12,406 (100) 3736 (100) 2076 (100)
Region, n (%)
Asia 18,386 (64) 5904 (55) 8781 (71) 2409 (64) 1292 (63)
Europe 3345 (12) 1152 (11) 1279 (10) 516 (14) 398 (19)
North America 5764 (20) 2941 (27) 1877 (15) 659 (18) 287 (14)
Rest of World 1439 (5) 728 (7) 469 (4) 152 (4) 90 (4)
GDP, n (%)
Low 9583 (33) 4705 (44) 3394 (27) 779 (21) 705 (34)
Mid 11,014 (38) 2143 (20) 6190 (50) 1921 (51) 760 (37)
High 8337 (29) 3877 (36) 2822 (23) 1036 (28) 602 (29)
Sex, n (%)
Male 14,206 (49) 5000 (47) 5952 (48) 2000 (54) 1254 (61)
Female 14,726 (51) 5723 (53) 6454 (52) 1736 (46) 813 (39)
No data 2 (0) 2 (0) . . . . . .
(continued)
May 2024 Revisions T-Descriptors 9th Edition TNM 753

Table 1. Continued
All pT pT1 pT2 pT3 pT4

Specific item n (%) n (%) n (%) n (%) n (%)

Age, n (%)
<65 13,449 (46) 5785 (54) 5190 (42) 1453 (39) 1021 (49)
65 15,430 (53) 4907 (46) 7197 (58) 2281 61) 1045 (51)
No data 55 (0) 33 (0) 19 (0) 2 (0) 1 (0)
NSCLC histology, n (%)
AIS 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
Adenocarcinoma 20,937 (72) 9171 (86) 8752 (71) 2016 (54) 998 (48)
Adenosquamous 615 (2) 89 (1) 356 (3) 120 (3) 50 (2)
Large cell 420 (1) 64 (1) 180 (1) 97 (3) 79 (4)
NSCLC NOS 105 (0) 26 (0) 31 (0) 28 (1) 20 (1)
Squamous 6857 (24) 1375 (13) 3087 (25) 1475 (39) 920 (45)
Resection, n (%)
Nonsurgical 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
Surgical R0 27,097 (94) 10,203 (95) 11,669 (94) 3419 (92) 1806 (87)
Surgical R1 or R2 858 (3) 92 (1) 367 (3) 197 (5) 202 (10)
Surgical R Unknown 979 (3) 430 (4) 370 (3) 120 (3) 59 (3)
Surgical Status Unknown 0 (0) 0 (0) 0 (0) 0 (0) 0 (0)
N-component, n (%)
N0 21,484 (74) 9441 (88) 8571 (69) 2381 (64) 1091 (53)
N1 3563 (12) 659 (6) 1774 (14) 684 (18) 446 (22)
N2 3770 (13) 606 (6) 2002 (16) 656 (18) 506 (24)
N3 117 (0) 19 (0) 59 (0) 15 (0) 24 (1)
The upper panel shows cT cases, lower panel pT cases. Criteria for T-descriptor analysis: cases were M0 NSCLC, had T descriptors to support the assigned
T-category (cases were excluded if the provided T descriptors failed to confirm the reported T-category), had valid N-category provided, and passed general
quality control screens. GDP categories were based on the 2017 World Bank GDP per capita, in which <$30,000 was categorized as low, $30,000 to $40,000 as
middle, and >$40,000 as high.
AIS, Adenocarcinoma in situ; cT, clinical T; GDP, gross domestic product; NOS, not otherwise specified; pT, pathologic T.

same eighth edition category, and similar to those in an
adjacent category, in both the clinical and pathologic
analysis, it was considered to be evidence in support of
potential recategorization. Hazard ratios for individual T
descriptors were compared with the survival of patients
in the T category above and below.
Decisions on Recommendations
Preliminary analyses of the new IASLC database were
presented at several virtual meetings of the Staging and
Prognostic Factors Committee Core Committee including
CRAB statisticians and at an in-person meeting on August 5,
2022 during the World Conference on Lung Cancer in
Vienna, Austria. Final recommendations were agreed on af-
ter a discussion of the new analyses during a virtual meeting
on October 4, 2022. Further detailed statistical analyses
were conducted by CRAB and finalized on October 4, 2023.
Results
T Component Validation
The existing T-component categories of the eighth
edition (Supplementary Table 1) were validated in the
ninth edition data set. These analyses generally revealed
good, ordered discrimination between the various T
categories and subcategories in various N and R status
cohorts. Furthermore, assessments of generalizability
were undertaken.
Survival curves of patients with clinical and pathologic
stage tumors by T categories revealed consistent ordering
with increasing T in an R-any, N0 cohort (Fig. 1A and B)
and in an N-any R0 cohort (Fig. 2A and B). The differences
between adjacent T categories and subcategories in these
graphs are generally clinically and statistically significant.
The validation of the existing eighth edition T descriptors
was further confirmed in clinical and pathologic stage
tumors with multivariable regression analyses (Table 2),
which adjusted for confounders of age, sex, pathologic
type, region, and stratified by data source.
Although appropriate ordering was maintained, the
pairwise comparison of survival of patients with clinical
T2b and T3 tumors was small and not statistically sig-
nificant (p ¼ 0.0767). However, the adjusted multivar-
iate analyses did confirm statistically different
outcomes in both clinical and pathologic-stage tumors
(Table 2).
The generalizability of the T-category classification
was further analyzed in multiple subsets. In general,
ordering and discrimination were revealed, although the
assessment is hampered in some subsets by limited
754 Van Schil et al Journal of Thoracic Oncology Vol. 19 No. 5

A 8th Ed Staging Criteria in 9th Ed Dataset

Clinical Pre-Treatment T-Categories
M0, N0, Any R
B 8th Ed Staging Criteria in 9th Ed Dataset
Pathologic Post-Surgical T-Categories
M0, N0, Any R

100% 100%

80%
Survival Probability (%)

80%

Survival Probability (%)

60%
60%

40%
Pairwise Pval M0, Any R, N0 Only 40%

20% Clinical T Pathologic T

20%
T1a vs T1b <0.0001 <0.0001
0%
3008 2617 2110 662 83 9 T1b vs T1c <0.0001 <0.0001 0%
8491 6829 4959 1626 258 33 1902 1578 1151 485 166 16
6008 4619 3271 1168 254 44 T1c vs T2a <0.0001 <0.0001 4665 3625 2496 1260 420 47
5083 3705 2478 900 172 30
1853 1221 776 309 72 18
T2a vs T2b <0.0001 <0.0001 2874 2149 1468 795 290 34
6851 5479 4050 1643 408 64
2315 1421 860 349 85 13 T2b vs T3 0.0767 0.0004 1720 1238 871 383 112 17
1213 651 362 143 44 3
2381 1687 1113 480 121 18
T3 vs T4 <0.0001 <0.0001 1091 692 426 209 68 9
0 2 4 6 8 10
Years from Diagnosis 0 2 4 6 8 10
Median 5-Year
Deaths / N in Years Estimate Years from Surgery
T1a 244 / 3008 NR 92% (91, 93) Median 5-Year
T1b 1239 / 8491 NR 84% (83, 85) Deaths / N in Years Estimate
T1c 1328 / 6008 NR 76% (75, 77) T1a 109 / 1902 NR 94% (93, 95)
T2a 1426 / 5083 9 (8, .) 69% (68, 71) T1b 481 / 4665 NR 89% (88, 91)
T2b 696 / 1853 6 (6, 7) 58% (55, 60) T1c 444 / 2874 NR 83% (81, 85)
T3 888 / 2315 7 (6, 7) 57% (54, 59) T2a 1469 / 6851 NR 78% (77, 79)
T4 570 / 1213 4 (4, 5) 46% (42, 49) T2b 491 / 1720 NR 69% (67, 72)
T3 799 / 2381 8 (8, .) 64% (62, 67)
T4 458 / 1091 7 (5, 8) 55% (51, 58)

Figure 1. (A and B) Survival curves for the different T categories to validate the eighth edition criteria for M0, N0, and any R
cases (clinical staging, left panel; pathologic staging, right panel).

sample size and likely confounders. Survival graphs Generally, a patient with cT1a NSCLC (any N, any R) has a
were evaluated for patients with clinical and pathologic 5-year survival rate of 91%, but for cT1a squamous cell
stage tumors by pathologic subsets (squamous versus carcinoma 5-year survival drops to 70% in contrast to
other NSCLC) (Supplementary Fig. 3A and B), subsets by cT1a nonsquamous cell carcinoma with a 5-year survival
region (Asia, Europe, North America, Rest of World) rate of 92%. An Asian patient with cT1a NSCLC has a 5-
(Supplementary Fig. 4A and B, and 5A and B), T categories year survival rate of 93%, in contrast to 79% for a North
in subsets by N status (N-any, N1, N2, and N3) American patient, and 71% for a European patient. Some
(Supplementary Fig. 6A and B, and 7A and B), subsets by of these subset analyses are likely strongly influenced by
treatment approach (surgical versus nonsurgical treat- confounding factors, for example, patients receiving neo-
ment, and primary resection versus neoadjuvant therapy adjuvant therapy are very likely to have had nodal
and resection) (Supplementary Fig. 8A and B), diagnosis involvement, and likely to have had a reasonable response,
before 2018 or from 2018 on (Supplementary Fig. 9A and thus, undergoing subsequent resection.
B), and finally subsets by EDC and batch data only The impact of the T category is potentially obscured
(Supplementary Fig. 10A and B). As illustrated in these by the impact of strong confounders. The granularity of
Supplementary figures, significant differences are noted the available data did not allow exploration or adjust-
between various regions, pathologic categories, and others. ment for such potential confounders.

A 8th Ed Staging Criteria in 9th Ed Dataset

Clinical Pre-Treatment T-Categories
Pairwise Pval
Clinical T
Any N, R0
Pathologic T
B 8th Ed Staging Criteria in 9th Ed Dataset
Pathologic Post-Surgical T-Categories
M0, Any N, R0 M0, Any N, R0
T1a vs T1b <0.0001 <0.0001
100% T1b vs T1c <0.0001 <0.0001 100%

80%
T1c vs T2a <0.0001 <0.0001 80%
Survival Probability (%)

Survival Probability (%)

T2a vs T2b <0.0001 <0.0001

60% T2b vs T3 0.7914 0.0271 60%

T3 vs T4 <0.0001 <0.0001
40% 40%

20% 20%

0% 0%
2917 2540 2043 645 81 9 1882 1561 1138 489 170 16
8433 6803 4955 1636 267 35 4878 3777 2608 1336 445 53
6175 4766 3388 1205 265 47 3443 2549 1724 945 340 41
5463 4014 2676 971 199 33 9121 7122 5107 2094 521 86
2166 1437 911 355 84 22 2547 1788 1201 532 164 23
2762 1786 1121 446 104 15 3419 2329 1520 674 172 24
1368 837 497 207 53 4 1806 1098 658 310 96 13
0 2 4 6 8 10 0 2 4 6 8 10
Years from Diagnosis Years from Surgery
Median 5-Year Median 5-Year
Deaths / N in Years Estimate Deaths / N in Years Estimate
T1a 247 / 2917 NR 91% (90, 93) T1a 113 / 1882 NR 94% (93, 95)
T1b 1256 / 8433 NR 84% (83, 85) T1b 604 / 4878 NR 87% (86, 88)
T1c 1402 / 6175 NR 76% (74, 77) T1c 697 / 3443 NR 78% (76, 79)
T2a 1570 / 5463 9 (9, .) 68% (67, 70) T2a 2502 / 9121 NR 72% (71, 73)
T2b 823 / 2166 6 (6, 7) 57% (55, 60) T2b 919 / 2547 8 (7, 10) 61% (59, 64)
T3 1015 / 2762 7 (7, 8) 59% (57, 61) T3 1305 / 3419 7 (7, 8) 59% (57, 61)
T4 584 / 1368 5 (5, 7) 52% (49, 55) T4 851 / 1806 5 (4, 5) 48% (46, 51)

Figure 2. (A and B) Survival curves for the different T categories to validate the eighth edition criteria for R0 cases only
(clinical staging, left panel; pathologic staging, right panel).
May 2024 Revisions T-Descriptors 9th Edition TNM 755

Table 2. Multivariable Survival Analyses of T-Component Stratified by Data Source

Clinical T-Component
N ¼ 33,545; R2 ¼ 36.3536

Specific item n/N (%) HR (95% CI) p-Value

T1b (vs. T1a) 8937/33,545 (26.64) 1.81 (1.59–2.07) <0.0001
T1c (vs. T1b) 6664/33,545 (19.87) 1.54 (1.43–1.65) <0.0001
T2a (vs. T1c) 6290/33,545 (18.75) 1.36 (1.27–1.45) <0.0001
T2b (vs. T2a) 2512/33,545 (7.49) 1.35 (1.25–1.45) <0.0001
T3 (vs. T2b) 3598/33,545 (10.73) 1.10 (1.01–1.19) 0.0239
T4 (vs. T3) 2475/33,545 (7.38) 1.52 (1.41–1.63) <0.0001
Age 65 (vs. <65) 18,962/33,545 (56.53) 1.43 (1.37–1.50) <0.0001
Female (vs. male) 17,603/33,545 (52.48) 0.96 (0.92–1.00) 0.0392
Europe (vs. Asia) 4002/33,545 (11.93) 1.55 (1.45–1.65) <0.0001
North America (vs. Asia) 6256/33,545 (18.65) 1.33 (1.26–1.41) <0.0001
Rest of the World (vs. Asia) 927/33,545 (2.76) 1.80 (1.59–2.04) <0.0001
Squamous (vs. nonsquamous) 8133/33,545 (24.25) 1.40 (1.34–1.47) <0.0001
Pathologic T-Component
N ¼ 28,771; R2 ¼ 34.5095

Specific item n/N (%) HR (95% CI) p-Value

T1b (vs. T1a) 5105/28,771 (22.09) 1.97 (1.62–2.40) <0.0001
T1c (vs. T1b) 3604/28,771 (15.57) 1.64 (1.47–1.82) <0.0001
T2a (vs. T1c) 9648/28,771 (24.96) 1.36 (1.25–1.48) <0.0001
T2b (vs. T2a) 2707/28,771 (8.07) 1.32 (1.23–1.42) <0.0001
T3 (vs. T2b) 3706/28,771 (13.36) 1.11 (1.02–1.20) 0.0115
T4 (vs. T3) 2046/28,771 (7.54) 1.40 (1.29–1.52) <0.0001
Age 65 (vs. <65) 15,377/28,771 (49.29) 1.45 (1.38–1.52) <0.0001
Female (vs. male) 14,677/28,771 (46.91) 0.85 (0.81–0.89) <0.0001
Europe (vs. Asia) 3310/28,771 (15.61) 1.41 (1.31–1.52) <0.0001
North America (vs. Asia) 5741/28,771 (23.85) 1.34 (1.26–1.43) <0.0001
Rest of the World (vs. Asia) 1424/28,771 (6.12) 1.38 (1.25–1.52) <0.0001
Squamous (vs. nonsquamous) 6848/28,771 (23.09) 1.31 (1.24–1.38) <0.0001
Clinical T-component (upper panel), pathologic T-component (lower panel).
Hazard Ratios reflect the risk associated among those with the trait, versus the reference category in parentheses. p-value from Wald c2 test in adjusted Cox
regression.
%, percent with the trait; 95% CI, 95% confidence interval; HR, hazard ratio; n, number of patients with the trait; N, total number of patients evaluated.

Separate analysis of the different T descriptors Chest Wall and PL 3 Invasion

were made regarding clinical and pathologic T1 and
T2 size only (Supplementary Fig. 11A and B), clin-
ical T2 descriptors (Supplementary Fig. 12), path-
ologic T2 descriptors (Supplementary Fig. 13),
clinical T3 descriptors (Supplementary Fig. 14),
pathologic T3 descriptors (Supplementary Fig. 15),
clinical T4 descriptors (Supplementary Fig. 16), and
pathologic T4 descriptors (Supplementary Fig. 17).
In general, a good discrimination was obtained be-
tween the various T categories. Some T descriptors
may be considered for upgrade to a higher category;
but currently, there were no consistent findings
between clinical and pathologic staging. In addition,
the sample sizes in several subgroups were too
small for meaningful analysis. These descriptors
should be considered for reevaluation in the 10th
edition.
The T descriptors subcommittee investigated the
hypothesis that patients with tumors with obvious chest
wall or PL 3 invasion had a worse prognosis compared
with patients with tumors involving the other single T3
descriptors, as was suggested by a detailed analysis of
the eighth edition IASLC database.5
No clinically relevant or statistically significant OS
differences were seen when comparing patients with
clinical-stage tumors involving chest wall or PL 3 invasion
versus those with tumors involving other single T3 de-
scriptors. This was seen in a cohort with any degree of
nodal involvement (N-any [Fig. 3A], 5-y OS 47% versus
51%, p ¼ 0.0721, respectively), and in a cohort without
nodal involvement (N0 [Fig. 3B], 5-y OS 57% versus 56%,
p ¼ 0.8093). The lack of a survival difference between
patients with clinical stage tumors involving chest wall or
PL 3 invasion versus those with tumors involving other
756 Van Schil et al Journal of Thoracic Oncology Vol. 19 No. 5

cT3M0 by Descriptor
A cT3M0 by Descriptor
Any N, Any R
B 100%
N0, Any R
100%

80%
80%

Survival Probability (%)

Survival Probability (%)

60%
60%

40% 40%

Median 5-Year Median 5-Year

20% 20%
Deaths / N in Years Estimate Deaths / N in Years Estimate
Any Chest Wall/PL3 335 / 734 4 (4, 5) 47% (43, 52) Any Chest Wall/PL3 171 / 450 7 (5, 8) 57% (52, 62)
Other T3 Single 1203 / 2796 5 (5, 6) 51% (49, 53) Other T3 Single 692 / 1781 6 (6, 7) 56% (54, 59)
T4 1449 / 2644 3 (2, 3) 37% (35, 39) T4 570 / 1213 4 (4, 5) 46% (42, 49)
0% 0%
Number at Risk Number at Risk
734 394 240 90 15 0 450 274 177 65 11 0
2796 1624 959 377 94 16 1781 1092 657 275 73 13
2644 1206 607 250 64 5 1213 651 362 143 44 3
0 2 4 6 8 10 0 2 4 6 8 10
Years from Diagnosis Years from Diagnosis

Pairwise p-values (unadjusted) Pairwise p-values (unadjusted)

Chest Wall/PL3 Other T3 Single T4 Chest Wall/PL3 Other T3 Single T4
Chest Wall/PL3 - - - Chest Wall/PL3 - - -
Other T3 Single 0.0721 - - Other T3 Single 0.8093 - -
T4 <0.0001 <0.0001 - T4 -
0.0003 <0.0001

Figure 3. (A and B) Survival curves according to the eighth edition criteria for patients with clinically staged T3 tumors with
any nodal involvement (left panel) and N0 only (right panel).

single T3 descriptors remained in both N-any and N0 co- On the other hand, clinically relevant and statistically
horts further subdivided into those undergoing surgical or significant lower survival was apparent when comparing
nonsurgical treatment (Supplementary Figs. 18 and 19). patients with pathologic stage tumors involving chest

pT3M0 by Descriptor
pT3M0 by Descriptor
A Any N, Any R
B N0, Any R

100%
100%

80%
80%
Survival Probability (%)

Survival Probability (%)

60%
60%

40%
40%

20% Median 5-Year Median 5-Year

20%
Deaths / N in Years Estimate Deaths / N in Years Estimate
Any Chest Wall/PL3 389 / 878 5 (5, 7) 53% (49, 56) Any Chest Wall/PL3 255 / 604 6 (5, 7) 55% (51, 60)
Other T3 Single 1035 / 2783 8 (7, 9) 60% (58, 62) Other T3 Single 527 / 1733 10 (9, .) 68% (66, 71)
T4 1027 / 2104 4 (4, 5) 46% (43, 48) T4 458 / 1091 7 (5, 8) 55% (51, 58)
0% 0%
878 553 356 133 28 2 604 401 259 98 22 1
2783 1887 1219 554 146 20 1733 1258 838 375 96 15
2104 1222 712 336 102 13 1091 692 426 209 68 9

0 2 4 6 8 10 0 2 4 6 8 10

Years from Surgery Years from Surgery

Pairwise p-values (unadjusted)

Pairwise p-values (unadjusted)
Chest Wall/PL3 Other T3 Single T4
Chest Wall/PL3 Other T3 Single T4
Chest Wall/PL3 - - -
Chest Wall/PL3 - - -
Other T3 Single <0.0001 - -
Other T3 Single <0.0001 - -
T4 0.0074 <0.0001 -
T4 0.9258 <0.0001 -

Figure 4. (A and B) Survival curves according to the eighth edition criteria for patients with pathologically staged T3 tumors
with any nodal involvement (left panel) and N0 only (right panel).
May 2024
wall or PL 3 invasion versus those with tumors involving
other single T3 descriptors. This was seen in an N-any
cohort (Fig. 4A) (5-y OS 53% versus 60%, p < 0.0001)
and in a N0 cohort (Fig. 4B) (5-y OS 55% versus 68%,
p < 0.0001).
Finally, the OS of patients with chest wall or PL 3
tumors remained better than that of patients with T4
tumors in most analyses (Fig. 3A and B and 4A), with the
exception of a pathologic stage N0, R-any cohort
(Fig. 4B).
Discussion
In the eighth edition of the TNM classification pro-
found changes were made to the T descriptors, espe-
cially related to specific tumor size.1 Increments of 1 cm
were implemented for T1 and T2 tumors, with 3 cm
remaining as the landmark separating T1 from T2 tu-
mors (Supplementary Table 1). T1 tumors were sub-
divided into T1a, T1b, and T1c, which is especially
relevant for smaller lesions that are screening- or
incidentally-detected pulmonary nodules. Recently,
these tumors have been extensively studied with the
main focus on the extent of resection to determine
whether sublobar resection, comprising wedge excision
and anatomical segmentectomy, is an oncologically valid
treatment for tumors 2 cm or smaller. Results of two
large randomized trials have recently become avail-
able.10–12 The Japan Clinical Oncology Group (JCOG)
0802 randomized phase 3 trial revealed a significant
survival advantage for anatomic segmentectomy
compared with lobectomy (p ¼ 0.0082), although local
recurrences were more frequently observed in the seg-
mentectomy arm.10 In contrast, the US Cancer And
Leukemia Group B (CALGB) 140503 (Alliance) random-
ized phase 3 trial revealed similar survival results for
wedge resections, segmentectomies, and lobectomies for
early lung cancers up to 2 cm in size, but strict operative
criteria were applied consisting of frozen section anal-
ysis of hilar lymph node station 10 and a minimum of
two mediastinal lymph node stations.11,12 A peculiar
finding was also that, in general, survival was better for
Japanese patients compared with North American pa-
tients, which is also observed in the IASLC database
(Supplementary Figs. 4 and 5). As illustrated in the
Supplementary figures, substantial survival differences
were also observed regarding specific pathology (squa-
mous versus nonsquamous), region (Asia versus Europe
versus North America), treatment (neoadjuvant versus
nonneoadjuvant), data collection (EDC versus batch
data), and time of diagnosis. The exact causes for these
differences cannot be determined from the database, but
are probably multifactorial, including genetic back-
ground, lifestyle, and the fact that most cases came from
Revisions T-Descriptors 9th Edition TNM 757
Asia, which may skew the OS results. It should also be
noted that we wanted to obtain a data set that has a
sufficient sample size to evaluate the different T de-
scriptors, rather than getting a data set that is a repre-
sentative sample of lung cancers worldwide. After a
thorough analysis of the database to inform the ninth
edition of the TNM classification, the descriptors put
forward by the eighth edition were found to be valid
with a good separation of the different survival curves as
outlined in the results.
For the first time, post-induction cases (ypT) could be
studied to a larger extent. OS was worse for all T cate-
gories compared with noninduction cases, suggesting
that biologic behavior may be different with more
aggressive tumors undergoing neoadjuvant therapy
(Supplementary Fig. 8). However, sample sizes for some
subgroups were small; as such, the findings should be
confirmed in larger patient populations.
As suggested by the T subcommittee, chest wall and
PL 3 invasion were studied in more detail. The preva-
lence of these tumors is less than 10%. Even large series
may suffer from a selection bias and specific treatment
protocols have not been clearly established.13 Prognostic
differences between different T3 descriptors were
studied in an analysis of the Surveillance, Epidemiology,
and End-Results database.14 The authors concluded that
different T descriptors have different outcomes and that
the T3 category should be reconsidered in the upcoming
edition of the TNM classification.14
An expert consensus statement on resection of chest
wall tumors and reconstruction was recently pub-
lished.15 The expert group concluded that for NSCLC
invading the chest wall, wide excision with neoadjuvant
followed by adjuvant therapy or not, is recommended for
cancers classified as T3-4N0-1M0.15
When analyzing survival data from the IASLC data-
base used to determine the eighth edition of the TNM
classification, a better OS was found in patients with
node-negative pT3 tumors defined by size or a separate
nodule, compared with pT3 tumors defined by chest wall
invasion, parietal pleural invasion, or by multiple T3
features.5 This raised the question of whether to subdi-
vide pT3 tumors into pT3a consisting of those tumors
defined by size or a separate nodule, and pT3b tumors
defined by invasion of the parietal pleura or chest wall.
However, to develop proposals for refinement in the
ninth edition, a significant difference was only found for
pathologic staging and not for clinically staged tumors.
Given these inconsistent findings, the consensus within
the T subcommittee was that there was insufficient ev-
idence to change the chest wall or PL 3 classification as a
T3 descriptor and reallocate it to the T4 category.
The discrepancy between clinical and pathologic
staging of parietal pleura and chest wall invasion can
758 Van Schil et al
most probably be explained by the low sensitivity of
chest computed tomography scanning in this setting,
which has been found to be only 42%, in contrast to the
detailed pathologic evaluation provided in the pT3
descriptor.16
Separate tumor nodules can be categorized as T3, T4,
or M1a if they are present in the same lobe, an ipsilateral
other lobe, or a contralateral lobe, respectively. A specific
article will address these multiple nodules as was done
for the eighth edition by Detterbeck et al.17
The data submitted to IASLC/CRAB was not suffi-
ciently reliable to analyze the eighth edition TNM pro-
posal to use invasive size rather than total size for the
size T-descriptor for part-solid and part-lepidic non-
mucinous lung adenocarcinomas, as this was officially
proposed by the IASLC in 20162 and adopted by the
Union for International Cancer Control and American
Joint Committee on Cancer in 2017.2,18,19 The period for
diagnosis of the cases submitted spanned from 2011 to
2019, hence, most cases submitted to IASLC/CRAB were
diagnosed before this recommendation was made.
Because most of the submitted cases failed to provide
the total size in addition to the required solid/invasive
size, this point could not be analyzed. It has been found
that application of this principle in pathologic stage I to
IIA nonmucinous lung adenocarcinomas may result in
downstaging of 22% of tumors.20
A similar issue relates to the entities of adenocar-
cinoma in situ and minimally invasive adenocarci-
noma, which were first defined by the IASLC/American
Thoracic Society/European Respiratory Society
adenocarcinoma classification in 2011 and only
recognized by the WHO Classification in 2015.21,22
Then adenocarcinoma in situ and minimally invasive
adenocarcinoma were formally added to the TNM
Stage Classification in 2017 near the end of the data
collection period for this database, making it difficult
to have suitable data to analyze regarding these newly
introduced entities.17–19 Also, spread through air
spaces is considered a specific pathologic descriptor
and is the subject of a separate article.23 Efforts will be
made to obtain higher quality data on these pathologic
issues in the collection of data to analyze for the 10th
edition.
In conclusion, after analyzing the survival results of
the current database established to inform the ninth
edition of the TNM classification, the T subcommittee
members proposed no changes to the current eighth
edition T descriptors for the ninth edition. Specific rec-
ommendations will be made when preparing the 10th
edition database, for which a specific working group has
been created. Currently, proposals include further
detailed analysis of neoadjuvant ypT cases, different T
descriptors, and invasive versus total tumor size for
Journal of Thoracic Oncology Vol. 19 No. 5
part-solid and part-lepidic lesions in a larger, multi-
centric patient population. Moreover, analysis in specific
subpopulations (e.g., specific regions, obesity, bio-
markers) and time-based intervals will be considered for
the 10th edition.
CRediT Authorship Contribution
Statement
Paul E. Van Schil: Conceptualization, Methodology,
Investigation, Writing-original draft.
Hisao Asamura: Conceptualization, Methodology,
Investigation, Writing-review and editing.
Katherine K. Nishimura, Dorothy Giroux: Meth-
odology, Formal analysis, Investigation, Resources, Data
curation, Writing-original draft, Writing-review, and
editing.
Ramon Rami-Porta, Frank Detterbeck: Conceptu-
alization, Methodology, Investigation, Writing-original
draft, Writing-review and editing.
Young Tae Kim, Pietro Bertoglio, Ayten K. Cangir,
Jessica Donington, Wentao Fang, Yolande Lievens,
Hui Liu, Gustavo Lyons, Shuji Sakai, William D.
Travis, Paula Ugalde, Jeff Yang, Masaya Yotsukura:
Conceptualization, Writing-review and editing.
Acknowledgments
This research is supported by a grant from AstraZeneca.
This research was supported in part through the NIH/
NCI Cancer Center Support Grant P30 CA008748, and
R01CA172253. KN acknowledges support from the In-
ternational Association for the Study of Lung Cancer for
employees of Cancer Research And Biostatistics (CRAB)
to attend the International Association for the Study of
Lung Cancer World Conference on Lung Cancer for the
Staging Project as statistical consultants.
Appendix 1
IASLC Staging and Prognostic Factors Committee
Hisao Asamura (chair), Keio University, Tokyo, Japan;
Valerie Rusch (chair elect) Memorial Sloan Kettering
Cancer Center, New York, New York; Ramon Rami-Porta
(past chair), Hospital Universitari Mutua Terrassa, Ter-
rassa, Spain; Luiz Henrique Araujo, Brazilian National
Cancer Institute, Rio de Janeiro, Brazil; David Beer,
University of Michigan, Ann Arbor, Michigan; Pietro
Bertoglio, IRCCS Azienda Ospedaliera Universitaria di
Bologna, Bologna, Italy; Ricardo Beyruti, University of
Sao Paulo Medical School, Sao Paolo, Brazil; Andrea Billè,
Guy’s Hospital, London, United Kingdom; Souheil Boubia,
Department of Thoracic surgery, University Hospital Ibn
Rochd, Laboratoire de Pathologie Cellulaire et Molécu-
laire Hassan II University of Casablanca, Casablanca,
Morocco; Elisabeth Brambilla, Centre Hospitalier
May 2024
Universitaire, Grenoble, France, University of Grenoble
Alpes, Grenoble, France; A. K. Cangir, Ankara University
Faculty of Medicine, Ankara, Turkey; David Carbone, The
Ohio State University, Columbus, Ohio; Vanessa Cilento,
Cancer Research And Biostatistics, Seattle, Washington;
Casey Connolly, IASLC, Denver, Colorado; Gail Darling,
University of Toronto, Toronto, Canada; Frank Detter-
beck, Yale University School of Medicine, New Haven,
Connecticut; Daniel Dibaba, Cancer Research And
Biostatistics, Seattle, Washington; Xavier Benoit
D’Journo, Aix-Marseille University, Marseille, France;
Jessica Donington, University of Chicago, Chicago, Illi-
nois; Wilfried Eberhardt, West German Cancer Centre,
University Hospital Essen, Essen, Germany; John
Edwards, Northern General Hospital, Sheffield, United
Kingdom; Megan Eisele, Cancer Research And Biostatis-
tics, Seattle, Washington; Jeremy Erasmus, M. D. Ander-
son Cancer Center, Houston, Texas; Wentao Fang,
Department of Thoracic Surgery, Shanghai Chest Hospi-
tal, Jiaotong University Medical School, Shanghai, Peo-
ple’s Republic of China; Dean Fennell, Leicester Cancer
Research Centre, Department of Genetics and Genome
Biology, University of Leicester and University Hospital
of Leicester National Health Service Trust, Leicester,
United Kingdom; Kwun Fong, University of Queensland
Thoracic Research Centre, Brisbane, Australia; Françoise
Galateau-Salle, Centre Hospitalier Universitaire, Caen,
France; Oliver Gautschi, Cancer Center, Cantonal Hospital
Lucerne, Lucerne, Switzerland; Ritu R. Gill, Beth Israel
Lahey Health, Boston, Massachussetts; Dorothy Giroux,
Cancer Research And Biostatistics, Seattle, Washington;
Meredith Giuliani, The Princess Margaret Cancer Centre/
University Health Network, Toronto, Ontario, Canada;
Department of Otolaryngology - Head and Neck Surgery,
The University of Toronto, Toronto, Ontario, Canada; Jin
Mo Goo, Seoul National University, Seoul, Republic of
Korea; Seiki Hasegawa, Hyogo College of Medicine,
Nishinomiya, Japan; Emily Goren, Cancer Research And
Biostatistics, Seattle, Washington; Fred Hirsch, Center for
Thoracic Oncology, Tisch Cancer Institute, Mount Sinai
Health System, New York, New York; Antje Hoering,
Cancer Research And Biostatistics, Seattle, Washington;
Hans Hoffman, Technical University of Munich, Munich,
Germany; Wayne Hofstetter, M. D. Anderson Cancer
Center, Houston, Texas; James Huang, Memorial Sloan
Kettering Cancer Center, New York, New York; Philippe
Joubert, Quebec Heart and Lung Institute, Quebec, Can-
ada; Kemp H. Kernstine, The University of Texas South-
western Medical Center, Dallas, Texas; Keith Kerr,
University of Aberdeen, School of Medicine and
Dentistry, Aberdeen, United Kingdom; Young Tae Kim,
Seoul National University, Seoul, Republic of Korea; Hong
Kwan Kim, Samsung Medical Center, Seoul, Republic of
Korea; Hedy Kindler, The University of Chicago Medical
Revisions T-Descriptors 9th Edition TNM 759
Center, Chicago, Illinois; Yolande Lievens, Radiation
Oncology department, Ghent University Hospital and
Ghent University, Ghent, Belgium; Hui Liu, Sun Yat-Sen
University Cancer Center, Guangdong Sheng, People’s
Republic of China; Donald E Low, Virginia Mason Medical
Center, Seattle, Washington; Gustavo Lyons, Buenos
Aires British Hospital, Buenos Aires, Argentina; Heber
MacMahon, University of Chicago, Chicago, Illinois; Aly-
son Mahar, School of Nursing, Queen’s University,
Ontario, Canada; Mirella Marino, IRCCS Regina Elena
National Cancer Institute, Rome, Italy; Edith M. Marom,
University of Tel Aviv, the Chaim Sheba Medical Center,
Tel Aviv, Israel; José-Maria Matilla, Valladolid University
Hospital, Valladolid, Spain; Jan van Meerbeeck, Antwerp
University and Antwerp University Hospital, Antwerp,
Belgium; Luis M. Montuenga, Center of Applied Medical
Research, University of Navarra, Pamplona, Spain and
Centro de Investigación Biomédica en Red de Cancer,
Spain; Andrew G.Nicholson, Royal Brompton and Hare-
field Hospitals, Guy’s and St Thomas’ NHS Foundation
Trust and Imperial College, London, United Kingdom;
Katie Nishimura, Cancer Research And Biostatistics,
Seattle, Washington; Anna Nowak, University of Western
Australia, Perth, Australia; Isabelle Opitz, University
Hospital Zurich, Zurich, Switzerland; Meinoshin Oku-
mura, National Hospital Organization Osaka Toneyama
Medical Center, Osaka, Japan; Raymond U. Osarogiagbon,
Baptist Cancer Center, Memphis, Tennessee; Harvey
Pass, New York University, New York, New York; Marc
de Perrot, University of Toronto, Toronto, Canada; Hel-
mut Prosch, Medical University of Vienna, Vienna,
Austria; David Rice, M. D. Anderson Cancer Center,
Houston, Texas; Andreas Rimner, Memorial Sloan Ket-
tering Cancer Center, New York, New York; Robert T.
Ripley, Baylor College of Medicine, Michael E. DeBakey
Department of Surgery, Houston, Texas; Adam Rosen-
thal, Cancer Research And Biostatistics, Seattle, Wash-
ington; Enrico Ruffini, University of Torino, Torino, Italy;
Shuji Sakai, Tokyo Women’s Medical University, Tokyo,
Japan; Paul Van Schil, Antwerp University and Antwerp
University Hospital, (Edegem) Antwerp, Belgium; Nav-
neet Singh, Postgraduate Institute of Medical Education
and Research, Chandigarh, India; Francisco Suárez,
Clínica Santa Maria, Santiago, Chile; Ricardo M. Terra,
University of Sao Paulo, Sao Paulo, Brazil; William D
Travis, Memorial Sloan Kettering Cancer Center, New
York, New York; Ming S. Tsao, Princess Margaret Cancer
Centre, Toronto, Canada; Paula Ugalde, Brigham &
Women’s Hospital, Boston, Massachusetts; Shun-ichi
Watanabe, National Cancer Center Hospital, Tokyo,
Japan; Ignacio Wistuba, The University of Texas M. D.
Anderson Cancer Center, Houston, Texas; Murry Wynes,
IASLC, Denver, Colorado; Yasushi Yatabe, National Can-
cer Center Hospital, Tokyo, Japan.
760 Van Schil et al
Advisory Board to the Lung Cancer Domain
Samuel Armato, The University of Chicago, Chicago;
Lawek Berzenji, University of Antwerp, Antwerp,
Belgium; Alex Brunelli, St. James’s University Hospital,
Leeds, UK; Giuseppe Cardillo, Azienda Ospedaliera San
Camilo Forlanini, Rome, Italy; Jason Chang, Memorial
Sloan Kettering Cancer Center, New York, New York;
Keneng Chen, Peking University, Beijing Cancer Hospital,
Beijing, People’s Republic of China; Wendy Cooper, Royal
Prince Alfred Hospital, NSW Health Pathology, Sydney,
Australia; Pier Luigi Filosso, University of Torino, Torino,
Italy; Liyan Jiang, Shanghai Chest Hospital, Shanghai,
People’s Republic of People’s Republic of China; Nagla
Karim, Inova Cancer Institute-University of Virginia,
Virginia; Peter Kneuertz, The Ohio State University Col-
lege of Medicine, Ohio; Mark Krasnik, Gentofte University
Hospital, Copenhagen, Denmark; Kaoru Kubota, Nippon
Medical School Hospital, Tokyo, Japan; Catherine Labbe,
Quebec Heart and Lung Institute, Quebec, Canada; Ho
Yun Lee, Samsung Medical Center, Sungkyunkwan Uni-
versity School of Medicine, Seoul, Korea; Eric Lim, Im-
perial College and the Royal Brompton Hospital, London,
United Kingdom; Geoffrey Liu, Princess Margaret Cancer
Centre, University of Toronto, Toronto, Canada; Hongxu
Liu, Cancer Hospital of China Medical University,
Liaoning Cancer Hospital & Institute, Liaoning, People’s
Republic of China; Philip Mack, Mount Sinai, New York,
New York; David Naidich, NYU-Langone Medical Center,
New York, New York; Mizuki Nishino, Brigham and
Women’s Hospital and Dana-Farber Cancer Institute,
Boston, Massachusetts; Marcin Ostrowski, Medical Uni-
versity of Gda nsk, Gda nsk, Poland; Charles Powell,
Mount Sinai School of Medicine, New York, New York;
Carolyn Presley, The Ohio State University, Ohio; Paul
Martin Putora, Kantonsspital St.Gallen, St. Gallen,
Switzerland; Natasha Rekhtman, Memorial Sloan Ket-
tering Cancer Center, New York, New York; Harry Ren,
Shanghai Pulmonary Hospital, Shanghai, People’s Re-
public of China; M Patricia Rivera, University of North
Carolina, Dept of Medicine, Chapel Hill, North Carolina;
Gaetano Rocco, Memorial Sloan Kettering Cancer Center,
New York, New York; Maria Teresa Ruiz Tzukazan,
Pontifical Catholic University of Rio Grande do Sul,
PUCRS, Porto Alegre, Brazil; Robert Samstein, Mount
Sinai, New York, New York; Yu Yang Soon, National
University Hospital, Harvard University Hospital,
Singapore; Kenichi Suda, Kindai University Faculty of
Medicine, Osaka, Japan; Martin Tammemägi, Department
of Community Health Sciences, Ontario, Canada; Lynn
Tanoue,Yale University, Dept of Medicine, New Haven,
Connecticut; Akif Turna, Istanbul University, Cerrahpasa
Medical School, Istanbul, Turkey; Benny Weksler, Uni-
versity of Tennesse Health Science Center, Tennessee;
Journal of Thoracic Oncology Vol. 19 No. 5
Terence Williams, City of Hope comprehensive cancer
center, California; Dawei Yang Zhongshan Hospital
Fudan University, Shanghai, People’s Republic of China;
Jeff Yang, Massachusetts General Hospital/Harvard
Medical School, Massachusetts; Masaya Yotsukura,
Department of Thoracic Surgery, National Cancer Center
Hospital, Tokyo, Japan.
Advisory Board to the Thymic Tumor Domain:
Usman Ahmad, Cleveland Clinic, Cleveland, Ohio,
Thoracic Surgery, Heart, Vascular and Thoracic Institute,
Cleveland Clinic and Cleveland Clinic Abu Dhabi, United
Arab Emirates; Sarit Appel, Sheba Medical Center, Ramat
Gan, Israel; Cecilia Brambilla, Royal Brompton and
Harefield hospital, Guy’s and St. Thomas NHS Foundation
Trust, London, UK; Conrad B. Falkson, Queen’s Univer-
sity, Kingston, Ontario, Canada; Pier Luigi Filosso, Uni-
versity of Torino, Torino, Italy; Giuseppe Giaccone, Weill-
Cornell Medicine, New York, New York; Francesco
Guerrera, University of Torino, Torino, Italy; Maurizio
Infante, University and Hospital Trust Azienda Ospeda-
liera Universitaria Integrata, Verona, Italy; Dong Kwan
Kim, Asan Medical Center, Seoul, and University of Ulsan
College of Medicine, Seoul, Republic of Korea; Marco
Lucchi, Division of Thoracic Surgery, Azienda Ospeda-
liero Universitaria Pisana, Pisa, Italy; Anja Roden, Labo-
ratory Medicine and Pathology, Mayo Clinic Rochester,
Minnesota; Charles B. Simone II, New York Proton Center
and Memorial Sloan Kettering Cancer Center, New York.
Advisory Board to the Esophageal Cancer Domain:
Mark Ferguson, The University of Chicago, Chicago.
Advisory Board to the Mesothelioma Domain:
Jennifer Sauter, Memorial Sloan Kettering Cancer
Center, New York, New York; Andrea Wolf, Icahn School
of Medicine at Mount Sinai, New York, New York.
Appendix 2. Chairpersons and Members
of the Subcommittees of the Lung
Cancer, Thymic Epithelial Tumors,
Pleural Mesothelioma, and Esophageal
Cancer Domains of the IASLC Staging and
Prognostic Factors Committee
IASLC Staging and Prognostic Factors Committee
Chair: Hisao Asamura.
Lung Cancer Domain
Lung Cancer Domain Chair: Paul Van Schil.
Lung Cancer Domain Vice Chair: Kemp H. Kernstine.
May 2024
Lung Cancer Domain T descriptors Sub-
committee. Hisao Asamura (chair), Young Tae Kim (co-
chair) Pietro Bertoglio, Ayten K. Cangir, Jessica Doning-
ton, Wentao Fang, Yolande Lievens, Hiu Liu, Gustavo
Lyons, Shuji Sakai, William Travis, Paula Ugalde, Paul
Van Schil, Jeff Yang, Masaya Yotsukura.
Lung Cancer Domain N Descriptors Sub-
committee. James Huang (chair), Raymond U. Osar-
ogiagbon (co-chair), Andrea Billè, Giuseppe Cardillo,
Kemp H. Kernstine, Hong Kwan Kim, Kaoru Kubota,
Yolande Lievens, Eric Lim, Edith M. Marom, Helmut
Prosch, Paul Martin Putora, David Rice, Gaetano Rocco,
Valerie Rusch, Paul Van Schil, Isabelle Opitz, Francisco
Suárez, Jeff Yang, Shun-ichi Watanabe.
Lung Cancer Domain M Descriptors Subcommittee. Kwun
Fong (chair), Wilfried Eberhardt (co-chair), Jeremy Eras-
mus, Yolande Lievens, Mirella Marino, Edith M. Marom,
Paul Martin Putora, Navneet Singh, Francisco Suárez.
Lung Cancer Domain Lepidic & GGO Sub-
committee. William Travis (chair), Philippe Joubert (co-
chair), Hisao Asamura, Frank Detterbeck, Giuseppe Car-
dillo, Wendy Cooper, Ritu R. Gill, Jin Mo Goo, Young Tae
Kim, Ho Yun Lee, Heber MacMahon, Edith M. Marom,
David Naidich, Andrew G. Nicholson, Mizuki Nishino,
Helmut Prosch, Ramon Rami-Porta, Valerie Rusch, Shuji
Sakai, Yasushi Yatabe, Shun-ichi Watanabe.
Lung Cancer Domain Neuroendocrine Tumors Sub-
committee. Ming Tsao (chair), Andrew G. Nicholson,
(co-chair), Ricardo Beyruti, Frank Detterbeck, Wilfried
Eberhardt, Pier Luigi Filosso, Yolande Lievens, Eric Lim,
Geoffrey Liu, José-Maria Matilla, Natasha Rekhtman,
William Travis, Jeff Yang, Yasushi Yatabe.
Lung Cancer Domain Stage Group Sub-
committee. Hisao Asamura (chair), Giuseppe Cardillo,
Frank Detterbeck, John Edwards, Kwun Fong, Meredith
Giuliani, James Huang, Kemp H. Kernstine, Edith M.
Marom, Andrew G. Nicholson, Ramon Rami-Porta, William
Travis, Ming Tsao, Paul Van Schil, Shun-ichi Watanabe.
Lung Cancer Domain Lymph Node Chart Sub-
committee. Shun-Ichi Watanabe (chair), Jin Mo Goo (co-
chair), Hisao Asamura, Hans Hoffman, James Huang,
Kemp H. Kernstine, Yolanda Lievens, Raymond U. Osar-
ogiagbon, Paul Martin Putora, Ramon Rami-Porta, Val-
erie Rusch, Paul Van Schil, Jeff Yang.
Lung Cancer Domain Validation and Methodology
Subcommittee. Frank Detterbeck (chair), Alyson Mahar
(co-chair), Hisao Asamura, Meredith Giuliani, Mirella
Marino, Raymond U. Osarogiagbon, Valerie Rusch.
Revisions T-Descriptors 9th Edition TNM 761
Lung Cancer Domain Prognostic Factors Sub-
committee. Frank Detterbeck (chair), Raymond U.
Osarogiagbon (co-chair), Alex Brunelli, Kwun Fong,
Meredith Giuliani, James Huang, Young Tae Kim, Mark
Krasnik, Hiu Liu, Jan van Meerbeeck, Luis M. Mon-
tuenga, Andrew G. Nicholson, Paul Martin Putora, Val-
erie Rusch, Robert Samstein, Navneet Singh, Martin
Tammemägi, Ricardo Terra, Ming Tsao, Akif Turna,
Terence Williams.
Lung Cancer Domain R Factor Subcommittee. John
Edwards (chair), Marcin Ostrowski (co-chair), Souheil
Boubia, Jessica Donnington, Hans Hoffman, Maurizio
Infante, Mirella Marino, Edith M. Marom, Jun Nakajima,
Andrew G. Nicholson, Paul Van Schil, William Travis,
Ming Tsao, Yasushi Yatabe.
Lung Cancer Domain Imaging Subcommittee. Jim Mo
Goo (chair), Ritu R. Gill (co-chair), Helmut Prosch (co-
chair), Samuel Armato, Hui Liu, Heber MacMahon, Edith
M. Marom, David Naidich, Charles Powell, Paul Van Schil,
William Travis.
Lung Cancer Domain Multiple Pulmonary Nodules
Subcommittee. Frank Detterbeck (chair), Edith Marom
(co-chair), Sarit Appel, Jason Chang, Keneng Chen, Nic-
olas Girard, Jin Mo Goo, Young Tae Kim, Heber Mac-
Mahon, Andrew G. Nicholson, Paul Martin Putora,
Natasha Rekhtman, M Patricia Rivera, Lynn Tanoue,
Ricardo M. Terra, William Travis, Paula Ugalde, Yasushi
Yatabe.
Lung Cancer Domain Molecular Subcommittee. David
Carbone (co-chair), Fred Hirsch (co-chair), Luiz Henrique
Araujo, Hisao Asamura, Elisabeth Brambilla, Jason Chang,
Frank Detterbeck, Oliver Gautschi, Nagla Karim, Keith
Kerr, Peter Kneuertz, Eric Lim, Philip Mack, José-Maria
Matilla, Luis M. Montuenga, Andrew G. Nicholson, Ray-
mond U. Osarogiagbon, Harvey Pass, Carolyn J Presley,
Ramon Rami-Porta, Natasha Rekhtman, Harry Ren,
Robert Samstein, Kenichi Suda, Ricardo M. Terra, William
Travis, Ming Tsao, Terence Williams, Ignacio Wistuba,
Dawei Yang, Yasushi Yatabe.
Lung Cancer Domain Database. Paula Ugalde (chair),
Pietro Bertoglio (co-chair), Sarit Appel, Philippe Joubert,
Catherine Labbe, Hongxu Liu, Gustavo Lyons, José-Maria
Matilla, Robert Samstein, Ricardo Terra, Maria Teresa
Ruiz Tzukazan, Benny Weksler.
Cancer Research And Biostatistics. Vanessa Cilento,
Daniel Dibaba, Megan Eisele, Dorothy Giroux, Emily
Goren, Antje Hoering, Katie Nishimura, Adam
Rosenthal.
762 Van Schil et al
Thymic Epithelial Tumors Domain
Enrico Ruffini (chair), James Huang (co-chair), Usman
Ahmad, Sarit Appel, Andrea Billè, Souheil Boubia, Cecilia
Brambilla, Ayten K. Cangir, Frank Detterbeck, Conrad
Falkson, Wentao Fang, Pier Luigi Filosso, Giuseppe
Giaccone, Nicolas Girard, Francesco Guerrera, Maurizio
Infante, Dong Kwan Kim, Marco Lucchi, Mirella Marino,
Edith M. Marom, Andrew Nicholson, Meinoshin Oku-
mura, Andreas Rimner, Anja Roden, Charles B. Simone II.
Thymic Domain T-descriptor: Andrew Nicholson
(chair), Cecilia Brambilla, Ayten K. Cangir, Maurizio
Infante, Mirella Marino, Edith M. Marom, Meinoshin
Okumura.
Thymic Domain N descriptor: Wentao Fang (chair),
Frank Detterbeck, Pier Luigi Filosso, Marco Lucchi, Edith
M. Marom, Charles B. Simone II.
Thymic Domain M descriptor: Nicolas Girard (chair),
Usman Ahmad, Sarit Appel, Conrad Falkson, Wentao
Fang, Giuseppe Giaccone, Dong Kwan Kim, Edith M.
Marom, Andreas Rimner.
Thymic Domain Database subcommittee: Pier Luigi
Filosso (chair), Usman Ahmad, Andrea Billè, Souheil
Boubia, Frank Detterbeck, Wentao Fang, Nicolas Girard,
Francesco Guerrera, James Huang, Dong Kwan Kim,
Meinoshin Okumura, Enrico Ruffini.
Pleural Mesothelioma Domain
Valerie Rusch (chair), Anna Nowak (co-chair), Pietro
Bertoglio, Andrea Billè, Ayten K. Cangir, Dean Fennell,
Françoise Galateau, Ritu R. Gill, Seiki Hasegawa, Hong
Kwan Kim, Hedy Kindler, Jan van Meerbeeck, Isabelle
Opitz, Harvey Pass, Marc de Perrot, David Rice, Andreas
Rimner, Robert T. Ripley, Jennifer Sauter, Ming Tsao,
David Waller, Andrea Wolf.
Esophageal Cancer Domain
Wentao Fang (chair), Xavier D’Journo (co-chair), Gail
Darling, Jeremy Erasmus, Mark Ferguson, Wayne Hof-
stetter, Hong Kwan Kim, Donald Low, Paula Ugalde.
Appendix 3. Participating Institutions in
the third phase of the IASLC Lung Cancer
Staging Project
Participating institutions ordered by the number
of eligible cases submitted
I. Yoshino, Japanese Joint Lung Cancer Registry,
Chiba, Japan (23,663 cases); T. Muley, Thoraxklinik,
University Hospital Heidelberg, Heidelberg, Germany
(8887 cases); W. Li, CAALC: West China Hospital,
Sichuan University, Chengdu, People’s Republic of China
(7345 cases); Y. Kim, Korean Association for Lung Can-
cer, Seoul, South Korea (4622 cases); H.K. Kim, Samsung
Medical Center, Seoul, South Korea (4130 cases); F.
Journal of Thoracic Oncology Vol. 19 No. 5
Griesinger, CRISP, Berlin, Germany (5482 cases)*; J.
Huang, Memorial Sloan Kettering Cancer Center, New
York (3146 cases); R. Osarogiagbon, Baptist Memorial
Hospital, Memphis (3021cases); S. Park, Seoul National
University Hospital, Seoul, South Korea (2542 cases); G.
Liu, Princess Margaret Cancer Center, Toronto, Canada
(2280 cases); N. Singh, Postgraduate Institute of Medical
Education & Research (PGIMER), Chandigarh, India
(2060 cases); P. Ugalde Figueroa, IUCPQ - Université
Laval, Quebec, Canada (2018 cases); P. Kneuertz, The
Ohio State University, Columbus (1819 cases); J. Shih,
Taiwan Society of Pulmonary and Critical Care Medicine,
Taipei, Taiwan (1481 cases); S. Jordan, The Royal
Brompton Hospital & E. Beddow, Harefield Hospital, part
of Guy’s & St. Thomas’ NHS Foundation Trust, London,
UK (1434 cases); B. McCaughan, University of Sydney,
Newtown, Australia (1368 cases); H. Liu, Liaoning Can-
cer Hospital, Shenyang, People’s Republic of China (1161
cases); A. K. Cangir, Ankara University School of Medi-
cine, Ankara-Sihhiye, Turkey (887 cases); A. Billè, Guy’s
Hospital, London, UK (882 cases); F. Leo, S Luigi Hospi-
tal, University of Turin, Orbassano, Torino, Italy (840
cases); H. Liu, Sun Yat-sen University Cancer Center,
Guangzhou, People’s Republic of China (825 cases); M.
Redman, SWOG-0819, Seattle (782 cases); H. Pass, NYU-
Langone Medical Center and Cancer Center, New York
(762 cases); J. Sun, CAALC: Shanghai Chest Hospital,
Shanghai Jiao Tong University, Shanghai, People’s Re-
public of China (634 cases); K. Fong, The University of
Queensland TPCH Thoracic Research Centre, Brisbane,
Australia (577 cases); R. Terra, University of Sao Paulo
Medical School, Sao Paulo, Brazil (555 cases); N. Wu,
Second Department of Thoracic Surgery, Peking Uni-
versity Cancer, Beijing, People’s Republic of China (455
cases); K. Chen, First Department of Thoracic Surgery,
Peking University Cancer H, Beijing, People’s Republic of
China (451 cases); A. Mohan, All India Institute of Med-
ical Sciences, New Delhi, India (448 cases); P. Van Schil,
University Hospital Antwerp, Dept of Pneumology, Ede-
gem, Belgium (304 cases); P. Bertoglio, IRCCS Sacro
Cuore-Don Calabria Hospital, Negrar, Italy (298 cases); C.
Yang, Massachusetts General Hospital, Boston (295
cases); R. Moises, Hospital de Rehabilitación Respiratoria
Maria Ferrer, Buenos Aires, Argentina (264 cases); A.
* CRISP is an AIO study (project no. AIO TRK-0315) under the medical leadership of the
Executive Committee (Prof. F. Griesinger (Oldenburg), Prof. M. Thomas (Heidelberg), Dr. M.
Sebastian (Frankfurt) and Dr. W. Eberhardt (Essen)). CRISP is conducted by AIO-Studien-
gGmbH (sponsor) in cooperation with iOMEDICO (conception, project management, anal-
ysis). CRISP is supported by AstraZeneca GmbH, Boehringer Ingelheim Pharma GmbH & Co.
KG, Bristol-Myers Squibb GmbH & Co. KGaA, Celgene GmbH, Eli Lilly Deutschland GmbH,
Merck Sharp & Dohme Sharp & Dohme GmbH, Novartis Pharma GmbH, Pfizer Pharma GmbH,
Roche Pharma AG and Takeda Pharma Vertrieb GmbH & Co. KG. However, these companies
have no input into or influence on data analysis, data interpretation, or writing of the
manuscript.
May 2024
Turna, Istanbul University-Cerrahpasa, Cerrahpasa
Medical Faculty, Istanbul, Turkey (238 cases); A. Celik,
Gazi University Faculty of Medicine, Ankara, Turkey (193
cases); M. Modesto Alapont, GCCB3: Consorcio Hospi-
talario Provincial de Castellón, Castellón, Spain (165
cases); L. Sánchez Moreno and M. Zabaleta Murguiondo,
GCCB3: Hospital Universitario Marqués de Valdecilla,
Santander, Spain (165 cases); C. Longo, Instituto COI, Rio
de Janeiro, Brazil (150 cases); H. Zhou, Suining Central
Hospital, Suining, People’s Republic of China (147 cases);
E. Pirondini, ASST San Gerardo, Monza, Italy (144 cases);
G. Lyons, Hospital Británico de Buenos Aires, Buenos
Aires, Argentina (143 cases); I. Gkiozos, Athens School of
Medicine, Athens, Greece (133 cases); K. Kernstine, UT
Southwestern Medical Center at Dallas, Dallas (132
cases); M. Serra Mitjans and R. Costa, GCCB3: Hospital
Mutua Terrassa. Barcelona (124 cases); M. Genovés
Crespo and A. Nuñez Ares, GCCB3: Complejo Hospitalario
Universitario of Albacete, Albacete, Spain (114 cases); C.
Lee, Seoul National University Bundang Hospital,
Seongnam, South Korea (104 cases); Y.K. Pang, Malay-
sian Thoracic Society, Kuala Lumpur, Malaysia (99
cases); N. Evans, Thomas Jefferson University Hospital,
Philadelphia (98 cases); F. Hirsch, Icahn School of Med-
icine at Mount Sinai, New York (84 cases); M. Ridai,
University Hospital of Casablanca, Casablanca, Morocco
(83 cases); C. Martínez Barenys and J. Sanz Santos,
GCCB3: Hospital Universitari Germans Trias i Pujol,
Badalona, Spain (77 cases); J. Sauleda Roig, Hospital
Universitari Son Espases, Palma de Mallorca, Spain (76
cases); H. Hoffmann, University of Munich - Division of
Thoracic Surgery, Munich, Germany (75 cases); M.A.
Iñiguez-García, National Institute of Respiratory Dis-
eases, Mexico City, Mexico (74 cases); L.H. de Lima
Araujo, Brazilian National Cancer Institute (INCA), Rio de
Janeiro, Brazil (72 cases); C. Grohé, Evangelische Lun-
genklinik Berlin - NET Registry, Berlin, Germany (71
cases); D. Ball, Peter MacCallum Cancer Institute, Mel-
bourne, Australia (70 cases); J.C. Peñalver Cuesta,
GCCB3: Fundación Instituto Valenciano de Oncología,
Valencia, Spain (65 cases); N. Tarek, Ain Shams Univer-
sity Hospitals, Cairo, Egypt (64 cases); D. Yang, CAALC:
Zhongshan Hospital Fudan University, Shanghai, People’s
Republic of China (63 cases); D. Sánchez, GCCB3: Hos-
pital Clinic, Barcelona, Spain (62 cases); J.A. Gullón
Blanco, GCCB3: Hospital Universitario San Agustín,
Avilés, Asturias, Spain (61 cases); L. Montuenga, CIMA/
Clínica Universidad de Navarra, Pamplona, Spain (55
cases); G. Galán Gil and R. Guijarro Jorge, GCCB3: Hos-
pital Clínico Universitario de Valencia, Valencia, Spain
(52 cases); C. García Rico, J.M. Matilla and B. de Vega
Sánchez, GCCB3: Hospital Clínico Universitario de Val-
ladolid, Valladolid, Spain (50 cases); A. Rodríguez Fuster
and V. Curall, GCCB3: Hospital del Mar, Barcelona, Spain
Revisions T-Descriptors 9th Edition TNM 763
(50 cases); L. Miravet, GCCB3: Hospital La Plana, Cas-
tellón, Spain (49 cases); J. Abal Arca and I. Parente
Lamelas, GCCB3: Complexo Hospitalario Universitario
Ourense, Ourense, Spain (48 cases); E. Melis, IRCCS
Regina Elena National Cancer Institute, Rome, Italy (41
cases); S. García Fuika, GCCB3: Hospital UA Txagorritxu,
Vitoria-Gasteiz, Spain (34 cases); K. Tournoy, University
Hospital Ghent, Ghent, Belgium (33 cases); M. Zuil Mar-
tin, GCCB3: Hospital Royo Villanova, Zaragoza, Spain (31
cases); L. García Aranguena, GCCB3: Hospital Sierrallana,
Torrelavega, Cantabria, Spain (28 cases); O. Arrieta,
Instituto Nacional de Cancerología, Mexico City, Mexico
(28 cases); M. G. Blum, Penrose Cancer Center, Colorado
Springs (28 cases); D. Mishra, BP Koirala Institute of
Health Sciences, Dharan, Nepal (25 cases); J.M. García
Prim, Hospital Clínico Universitario de Santiago, Santiago
de Compostela, Spain (25 cases); M. Mariñán Gorospe,
Hospital San Pedro de Logroño, Logroño, Spain (24
cases); R. Stirling, The Alfred Hospital, Melbourne,
Australia (23 cases); B. Steen, GCCB3: Hospital de
Alcorcón, Madrid, Spain (23 cases); D. Chimondeguy,
Hospital Universitario Austral, Buenos Aires, Argentina
(22 cases); F.J. Montoro Zulueta, GCCB3: Hospital Uni-
versitario Infanta Sofía, San Sebastian de los Reyes, Spain
(22 cases); M. Paradela de la Morena and A. Souto
Alonso, GCCB3: Complejo Hospitalario Universitario de A
Coruña, La Coruña, Spain (21 cases); R. Cordovilla and T.
Gómez Hernández, GCCB3: Hospital Universitario de
Salamanca, Salamanca, Spain (21 cases); C. Thomas, Mayo
Clinic Rochester, Rochester, Minessota (20 cases); J. Her-
nández Hernández, and I. Lobato Astiárraga, GCCB3:
Complejo Asistencial de Ávila, Ávila, Spain (19 cases); I.
Macía Vidueira and S.Padrones, GCCB3: Hospital de Bell-
vitge, Barcelona, Spain (16 cases); J.R. Jarabo Salcedo and
B. Morales Chacón, GCCB3: Hospital Clínico San Carlos,
Madrid, Spain (16 cases); Y. L. Wu, Guangdong General
Hospital, Guangzhou, People’s Republic of China (15
cases); E. Martínez Tellez, J.C. Trujillo and V. Pajares Ruiz,
GCCB3: Hospital de la Santa Creu i Sant Pau, Barcelona,
Spain (14 cases); L. Bai, CAALC: Xinqiao Hospital, No. 3
Army Medical University, Chongqing, People’s Republic of
China (14 cases); R. Magaroles and L. de Esteban Júlvez,
Hospital Universitari Joan XXIII, Tarragona, Spain (14
cases); R. Melchor Íñiguez, Fundación Jiménez Díaz,
Madrid, Spain (14 cases); I.R. Embun Flor and P.Teller
Justes, GCCB3: Hospital Clínico Universitario Lozano
Blesa, Zaragoza, Spain (13 cases); C.M. Ariza Prota,
GCCB3: Hospital Universitario Asturias, Oviedo, Spain (13
cases); M. J. Pavón Fernández, Hospital Severo Ochoa,
Leganés, Spain (13 cases); J. Menéndez, Hospital General
de Agudos José M. Penna, Buenos Aires, Argentina (11
cases); S. Defranchi, Hospital Universitario-Fundación
Favaloro, Buenos Aires, Argentina (11 cases); E. Martínez
Tellez, Hospital de Terrassa, Terrassa, Spain (11 cases).
764 Van Schil et al
The following institutions submitted 10 eligible
cases or less listed alphabetically
M. Curado, A.C. Camargo Cancer Center, Sao Paulo,
Brazil; A. Badawy, Alexandria University, Alexandria,
Egypt; X. Zhang, CAALC: Henan Provincial People’s
Hospital, Zhengzhou, People’s Republic of China; Q.
Wang, CAALC: The Second Hospital of Dalian Medical
University, Dalian, People’s Republic of China; S. Han,
CAALC: Zhongda Hospital Affiliated to Southeast Uni-
versity, Nanjing, People’s Republic of China; D. Levy
Faber, Carmel Medical Center, Haifa, Israel; P. García
Herreros, Clínica Cardiovid, Medellín, Antioquia,
Colombia; F. Suárez, Clínica Santa Maria, Santiago, Chile;
D. Subotic, Clinical Center of Serbia, Belgrade, Serbia; T.
Horvath, Czech Republic-Urazova nemocnice Brno,
BRNO, Czech Republic; M. Velásquez, Fundación Clínica
Valle del Lili, Cali, Colombia; T. Ruiz Albi, GCCB3: Hos-
pital Rio Hortega, Valladolid, Spain; M. Serraj, Hassan II
University Hospital, Fez, Morocco; V. Baysungur, Health
Science University Sureyyapasa Thoracic and Chest Dis-
ease, Istambul, Turkey; M. Raíces, Hospital Italiano de
Buenos Aires, Argentina; M.J. Pavón Fernández, GCCB3:
Hospital Severo Ochoa, Leganés, Madrid, Spain; V. Cvi-
janovic, Military Medical Academy, Belgrade, Serbia; M.
Zereu, Pavilhao Pereira Filho, Santa Casa de Porto Alegre,
Brazil; W. Aguiar, SECITOR - Servico de Cirurgia Toracica
de Recife, Recife, Brazil.
Supplementary Data
Note: To access the supplementary material accompa-
nying this article, visit the online version of the Journal of
Thoracic Oncology at www.jto.org and at https://doi.
org/10.1016/j.jtho.2023.12.006.
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