TY - JOUR T1 - Strength and weakness of the new TNM classification for lung cancer JF - European Respiratory Journal JO - Eur Respir J SP - 237 LP - 239 DO - 10.1183/09031936.00016210 VL - 36 IS - 2 AU - R. Rami-Porta AU - P. Goldstraw Y1 - 2010/08/01 UR - http://erj.ersjournals.com/content/36/2/237.abstract N2 - The article by Strand et al. 1 on the evaluation of the new tumour, node, metastasis (TNM) classification and staging system for lung cancer raises important questions on the validity of the classification and its therapeutic implications in clinical practice. The authors analysed a population-based series of 1,885 patients who underwent operation for lung cancer and who were registered at the Cancer Registry of Norway from 2001 to 2005. They pathologically classified these tumours according to the 6th 2 and 7th 3 editions of the TNM classification to assess their prognostic capacity, and found that the 7th edition did not improve the overall predictive ability of the staging system. Moreover, based on the current indications of therapy, nearly one-fifth of the patients could be offered different treatment options because of the rearrangement of some TNM subsets in different stages. Whether this different treatment will result in an improved prognosis is unknown. Regarding the prognostic capacity of the 7th edition of the TNM classification, the authors' results contradict those of the International Association for the Study of Lung Cancer (IASLC), whose database of >100,000 patients collected worldwide was used to revise the 6th edition of the classification 4, and those of others whose patient series have validated most of the changes introduced in the 7th edition. Soon after the publication of the recommended changes for the new edition, independent groups validated them based on their own data or on data from registries. Zell et al. 5 and Ou and Zell 6, 7 found that the proposed changes better reflected survival for advanced bronchioloalveolar carcinoma and for small cell lung cancer, and validated the revisions of the T4 and M descriptors, respectively. … ER -