• Frank C Detterbeck, Vanessa Bolejack, Douglas A Arenberg, John Crowley, Jessica S Donington, Wilbur A Franklin, Nicolas Girard, Edith M Marom, Peter J Mazzone, Andrew G Nicholson, Valerie W Rusch, Lynn T Tanoue, William D Travis, Hisao Asamura, Ramón Rami-Porta, IASLC Staging and Prognostic Factors Committee, Advisory Boards, Multiple Pulmonary Sites Workgroup, and Participating Institutions.
• Department of Surgery, Yale University, New Haven, Connecticut. Electronic address: frank.detterbeck@yale.edu.
• J Thorac Oncol. 2016 May 1; 11 (5): 681-692.

IntroductionSeparate tumor nodules with the same histologic appearance occur in the lungs in a small proportion of patients with primary lung cancer. This article addresses how such tumors can be classified to inform the eighth edition of the anatomic classification of lung cancer. Separate tumor nodules should be distinguished from second primary lung cancer, multifocal ground glass/lepidic tumors, and pneumonic-type lung cancer, which are addressed in separate analyses.MethodsSurvival of patients with separate tumor nodules in the International Association for the Study of Lung Cancer database were analyzed. This was compared with a systematic literature review.ResultsSurvival of clinically staged patients decreased according to the location of the separate tumor nodule relative to the index tumor (same lobe > same side > other side) in N0 and N-any cohorts (all M0 except possible other-side nodules). However, there was also a decrease in the proportion of patients resected; among only surgically resected or among nonresected patients no survival differences were noted. There were no survival differences between patients with same-lobe nodules and those with other T3 tumors, between patients with same-side nodules and those with T4 tumors, and patients with other-side nodules and those with other M1a tumors. The data correlated with those identified in a literature review.ConclusionsTumors with same-lobe separate tumor nodules (with the same histologic appearance) are recommended to be classified as T3, same-side nodules as T4, and other-side nodules as M1a. Thus, there is no recommended change between the seventh and eighth edition of the TNM classification of lung cancer.Copyright © 2016 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

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