Change and continuity: On the 9th UICC/IASLC/AJCC TNM staging system for thymic tumors_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Fenghao , GU Zhitao , MAO Teng , XU Ning , ZHANG Xuefei , HAO Xiuxiu ,  FANG Wentao

Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, P. R. China;

Corresponding author：

FANG Wentao, Email: vwtfang12@shchest.org

Keywords：

Thymic tumors; the 9^th edition; TNM staging system

DOI：

10.7507/1007-4848.202311063

Video：

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The announcement of the 9^th edition of TNM staging system for thymic tumors was one of the highlights at the World Conference on Lung Cancer 2023. The revision, based on a larger and more detailed database, provides changes and confirmation from the last system. The 9^th edition of TNM staging system aims to balance statistical significance and clinical feasibility. The birth of an improved TNM staging system heralds the changes that will follow in clinical practice and scientific research.

Citation： YU Fenghao, GU Zhitao, MAO Teng, XU Ning, ZHANG Xuefei, HAO Xiuxiu, FANG Wentao. Change and continuity: On the 9th UICC/IASLC/AJCC TNM staging system for thymic tumors. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(2): 196-202. doi: 10.7507/1007-4848.202311063 Copy

1.	Filosso PL, Ruffini E, Lausi PO, et al. Historical perspectives: The evolution of the thymic epithelial tumors staging system. Lung Cancer, 2014, 83(2): 126-132.
2.	Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S65-S72.
3.	Meurgey A, Girard N, Merveilleux du Vignaux C, et al. Assessment of the ITMIG Statement on the WHO histological classification and of the eighth TNM Staging of thymic epithelial tumors of a series of 188 thymic epithelial tumors. J Thorac Oncol, 2017, 12(10): 1571-1581.
4.	Ruffini E, Fang W, Guerrera F, et al. The International Association for the Study of Lung Cancer Thymic Tumors Staging Project: The impact of the eighth edition of the Union for International Cancer Control and American Joint Committee on Cancer TNM Stage Classification of Thymic Tumors. J Thorac Oncol, 2020, 15(3): 436-447.
5.	Ruffini E, Huang J, Cilento V, et al. The IASLC Thymic Epithelial Tumors Staging Project: Proposal for a stage classification for the forthcoming (9th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, S1556-0864(23): 00804-3.
6.	Rimner A, Ruffini E, Cilento V, et al. The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: An overview of the central database informing revision of the forthcoming (ninth) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, 18(10): 1386-1398.
7.	Liu H, Gu Z, Qiu B, et al. A recurrence predictive model for thymic tumors and its implication for postoperative management: A Chinese Alliance for Research in Thymomas Database Study. J Thorac Oncol, 2020, 15(3): 448-456.
8.	Okumura M, Yoshino I, Yano M, et al. Tumour size determines both recurrence-free survival and disease-specific survival after surgical treatment for thymoma. Eur J Cardiothorac Surg, 2019, 56(1): 174-181.
9.	Okumura M, Marino M, Cilento V, et al. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: Proposal for the T component for the forthcoming (ninth) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, S1556-0864(23): 00751-7.
10.	Roden AC, Judge M, den Bakker MA, et al. Dataset for reporting of thymic epithelial tumours: Recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology, 2023, 10.1111s.
11.	Gu Z, Hao X, Liu Y, et al. Minimally invasive thymectomy could be attempted for locally advanced thymic malignancies: A real-world study with propensity score-matched analysis. J Thorac Oncol, 2023, 18(5): 640-649.
12.	樊代明, 方文涛, 主编. 中国肿瘤整合诊治指南—胸腺肿瘤. 天津: 天津科学技术出版社. 2022.
13.	NCCN Guidelines in Oncology for Thymomas and Thymic Carcinomas V. 1 2023. URL: https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf. Accessed on 2023-11-02.
14.	Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stageⅡand Ⅲ thymoma—An analysis of the international thymic malignancies interest group retrospective database. J Thorac Oncol, 2016, 11(10): 1785-1792.
15.	Omasa M, Date H, Sozu T, et al. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage Ⅱ and Ⅲ thymic epithelial tumors: The Japanese Association for Research on the Thymus Database Study. Cancer, 2015, 121(7): 1008-1016.
16.	Fang W, Girard N, Cilento V, et al. The IASLC Thymic Epithelial Tumors Staging Project: Proposals for the N and the M components for the forthcoming (9th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, S1556-0864(23): 02257-8.
17.	Marom EM, Fang W, Ruffini E, et al. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: A re-assessment of the International Thymic Malignancy Interest Group/International Association for the Study of Lung Cancer Lymph Node Map for Thymic Epithelial Tumors for the forthcoming ninth edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, 18(12): 00803-1688.
18.	Kondo K, Van Schil P, Detterbeck FC, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S81-S87.
19.	Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignancies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
20.	Gu Z, Wei Y, Fu J, et al. Lymph node metastases in thymic malignancies: A Chinese Alliance for Research in Thymomas retrospective database analysis. Interact Cardiovasc Thorac Surg, 2017, 25(3): 455-461.

1. Filosso PL, Ruffini E, Lausi PO, et al. Historical perspectives: The evolution of the thymic epithelial tumors staging system. Lung Cancer, 2014, 83(2): 126-132.
2. Detterbeck FC, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S65-S72.
3. Meurgey A, Girard N, Merveilleux du Vignaux C, et al. Assessment of the ITMIG Statement on the WHO histological classification and of the eighth TNM Staging of thymic epithelial tumors of a series of 188 thymic epithelial tumors. J Thorac Oncol, 2017, 12(10): 1571-1581.
4. Ruffini E, Fang W, Guerrera F, et al. The International Association for the Study of Lung Cancer Thymic Tumors Staging Project: The impact of the eighth edition of the Union for International Cancer Control and American Joint Committee on Cancer TNM Stage Classification of Thymic Tumors. J Thorac Oncol, 2020, 15(3): 436-447.
5. Ruffini E, Huang J, Cilento V, et al. The IASLC Thymic Epithelial Tumors Staging Project: Proposal for a stage classification for the forthcoming (9th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, S1556-0864(23): 00804-3.
6. Rimner A, Ruffini E, Cilento V, et al. The International Association for the Study of Lung Cancer Thymic Epithelial Tumors Staging Project: An overview of the central database informing revision of the forthcoming (ninth) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, 18(10): 1386-1398.
7. Liu H, Gu Z, Qiu B, et al. A recurrence predictive model for thymic tumors and its implication for postoperative management: A Chinese Alliance for Research in Thymomas Database Study. J Thorac Oncol, 2020, 15(3): 448-456.
8. Okumura M, Yoshino I, Yano M, et al. Tumour size determines both recurrence-free survival and disease-specific survival after surgical treatment for thymoma. Eur J Cardiothorac Surg, 2019, 56(1): 174-181.
9. Okumura M, Marino M, Cilento V, et al. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: Proposal for the T component for the forthcoming (ninth) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, S1556-0864(23): 00751-7.
10. Roden AC, Judge M, den Bakker MA, et al. Dataset for reporting of thymic epithelial tumours: Recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology, 2023, 10.1111s.
11. Gu Z, Hao X, Liu Y, et al. Minimally invasive thymectomy could be attempted for locally advanced thymic malignancies: A real-world study with propensity score-matched analysis. J Thorac Oncol, 2023, 18(5): 640-649.
12. 樊代明, 方文涛, 主编. 中国肿瘤整合诊治指南—胸腺肿瘤. 天津: 天津科学技术出版社. 2022.
13. NCCN Guidelines in Oncology for Thymomas and Thymic Carcinomas V. 1 2023. URL: https://www.nccn.org/professionals/physician_gls/pdf/thymic.pdf. Accessed on 2023-11-02.
14. Rimner A, Yao X, Huang J, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stageⅡand Ⅲ thymoma—An analysis of the international thymic malignancies interest group retrospective database. J Thorac Oncol, 2016, 11(10): 1785-1792.
15. Omasa M, Date H, Sozu T, et al. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage Ⅱ and Ⅲ thymic epithelial tumors: The Japanese Association for Research on the Thymus Database Study. Cancer, 2015, 121(7): 1008-1016.
16. Fang W, Girard N, Cilento V, et al. The IASLC Thymic Epithelial Tumors Staging Project: Proposals for the N and the M components for the forthcoming (9th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, S1556-0864(23): 02257-8.
17. Marom EM, Fang W, Ruffini E, et al. The International Association for the Study of Lung Cancer Thymic Epithelial Tumor Staging Project: A re-assessment of the International Thymic Malignancy Interest Group/International Association for the Study of Lung Cancer Lymph Node Map for Thymic Epithelial Tumors for the forthcoming ninth edition of the TNM classification of malignant tumors. J Thorac Oncol, 2023, 18(12): 00803-1688.
18. Kondo K, Van Schil P, Detterbeck FC, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: Proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol, 2014, 9(9 Suppl 2): S81-S87.
19. Fang W, Wang Y, Pang L, et al. Lymph node metastasis in thymic malignancies: A Chinese multicenter prospective observational study. J Thorac Cardiovasc Surg, 2018, 156(2): 824-833.
20. Gu Z, Wei Y, Fu J, et al. Lymph node metastases in thymic malignancies: A Chinese Alliance for Research in Thymomas retrospective database analysis. Interact Cardiovasc Thorac Surg, 2017, 25(3): 455-461.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Change and continuity: On the 9th UICC/IASLC/AJCC TNM staging system for thymic tumors

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