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Table 69-1

Tumor, Node, Metastasis International Staging System for Lung Cancer

Comparison of Survival by Stage in TNM Sixth and Seventh Editions
StageTNM Sixth EditionTNM Seventh Edition5-Year Survival, %a
IAT1N0M0T1a-T1bN0M073
IBT2N0M0T2aN0M058
IIAT1N1M0T1a-T2aN1M0 or46
T2bN0M0
IIBT2N1M0 orT2bN1M0 or36
T3N0M0T3N0M0
IIIAT3N1M0 orT1a-T3N2M0 or24
T1-3N2M0T3N1M0 or
T4N0-1M0
IIIBAny T N3M0T4N2M0 or9
T4 Any N M0T1a-T4N3M0
IVAny T Any N M1Any T Any N M1a or M1b13
Sixth EditionSeventh Edition
Tumor (T)
T1Tumor 3 cm diameter without invasion more proximal than lobar bronchusTumor 3 cm diameter, surrounded by lung or visceral pleura, without invasion more proximal than lobar bronchus
T1a Tumor 2 cm in diameter
T1b Tumor >2 cm but 3 cm in diameter
T2Tumor >3 cm diameter or tumor of any size with any of the following:Tumor >3 cm but 7 cm with any of the following:
Visceral pleural invasion Involves main bronchus, 2 cm distal to carina
Atelectasis of less than entire lung Invades visceral pleura
Proximal extent at least 2 cm from carina Associated with atelectasis or obstructive pneumonitis extending to hilar region but not involving the entire lung
T2a Tumor >3 cm but 5 cm in diameter
T2b Tumor >5 cm but 7 cm in diameter
T3Tumor of any size that invades any of the following: chest wall, diaphragm, mediastinal pleura, parietal pericardiumTumor >7 cm or directly invades any of the following: chest wall (including superior sulcus tumors), phrenic nerve, mediastinal pleura, parietal pericardium
Tumor <2 cm distal to carinaTumor <2 cm distal to carina but without involvement of carina
Tumor with associated atelectasis or obstructive pneumonitis of entire lung
Separate tumor nodule(s) in same lobe
T4Tumor of any size that invades any of the following: mediastinum, heart or great vessels, trachea, esophagus, vertebral body, carinaTumor of any size that invades any of the following: mediastinum, heart or great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, carina
Tumor with malignant pleural or pericardial effusionSeparate tumor nodule(s) in a different ipsilateral lobe
Separate tumor nodules in same lobe
Nodes (N)
N0No regional lymph node metastasisNo regional lymph node metastasis
N1Metastasis in ipsilateral peribronchial and/or hilar lymph node(s)Metastasis in ipsilateral peribronchial and/or hilar lymph node(s) and intrapulmonary node(s), including involvement by direct extensions
N2Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)
N3Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene or supraclavicular lymph node(s)Metastasis in contralateral mediastinal, hilar, ipsilateral or contralateral scalene or supraclavicular lymph node(s)
Metastasis (M)
M0No distant metastasisNo distant metastasis
M1Distant metastasis (includes tumor nodules in different lobe from primary)Distant metastasis
M1a Separate tumor nodules in a contralateral lobe
Tumor with pleural nodules or malignant pleural or pericardial effusion
M1b Distant metastasis

aSurvival according to the seventh edition.

Abbreviation: TNM, tumor-node-metastasis.

Source: Bottom portion of table reproduced with permission from P Goldstraw et al: J Thorac Oncol 2:706, 2007.