Meet the new boss: lung cancer staging

Lung cancer staging remains a moving target. Since the first TNM staging system was established by Mountain and colleagues there have been seven revisions (1,2). A jaded viewer may understandably feel that these revisions have proven to be refinements more than paradigm shifts. Attempts to incorporate novel technologies or genomic platforms have proven inadequate or worse, and have not changed standard of care for non-small cell lung cancer (NSCLC) (3-6). Heineman and colleagues explore NSCLC staging with an emphasis on how stage affects decision to administer adjuvant chemotherapy in the review article, “Clinical staging of NSCLC: current evidence and implications for adjuvant chemotherapy”. Although a new 8th edition of NSCLC staging has been published, it is not in effect yet and all existing data uses the Union Internationale Contre le Cancer (UICC) and American Joint Committee on Cancer (AJCC) 7th edition. Heineman and colleagues present data on clinical staging accuracy, compared to the gold standard surgical pathologic staging. Largely, we believe that the community at large and our institution in particular support and share most of their recommendations