The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Application and Interpretation of the Residual Tumor Classification for Lung Cancer-Results from an International Survey Among Pathologists and Thoracic Surgeons

Hans Hoffmann ¹, Andrew G Nicholson ², Frank C Detterbeck ³

¹Division of Thoracic Surgery, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.
²Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas National Health Service Foundation, Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom.
³Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
⁴Department of Pathobiology, University Health Network (UHN), Princess Margaret Cancer Centre, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
⁵Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland.
⁶Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; and Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
⁷Department of Surgical Pathology, Weill Cornell Medicine, New York, New York.
⁸Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
⁹Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York.
¹⁰Department of Thoracic and Vascular Surgery, Antwerp University Hospital and Antwerp University, Antwerp, Belgium.
¹¹Department of Cardiothoracic Surgery, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, United Kingdom.

⁰Division of Thoracic Surgery, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany.

Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer +

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December 15, 2024

View abstract on PubMed

Summary

The residual tumor (R) classification for lung cancer is inconsistently applied globally by pathologists and surgeons. Significant regional variations exist in its reporting and interpretation, hindering standardized lung cancer staging.

Area Of Science

Oncology
Pathology
Thoracic Surgery

Background

The residual tumor (R) classification is crucial for lung cancer staging and prognosis.
Standardized application of the R classification is essential for consistent patient management and research.

Purpose Of The Study

To evaluate the current practices and opinions of pathologists and thoracic surgeons on the application and interpretation of the R classification for lung cancer.
To identify global variations in the use and assignment of the R status in lung cancer resection reports.

Main Methods

A survey was distributed to 623 International Association for the Study of Lung Cancer (IASLC) members, comprising pathologists and thoracic surgeons.
The online questionnaire included 12 questions focusing on the R classification's application and interpretation.
A response rate of 72% was achieved, with 144 pathologists and 303 surgeons providing data.

Main Results

Significant geographic disparities were observed in R classification reporting; 70% of US/Canadian pathologists do not report R status.
Responsibility for assigning R category varies, with pathologists predominantly in Europe/UK and surgeons in China/Japan/US.
The "uncertain resection" category is largely unutilized, except in limited centers in Japan and the UK.

Conclusions

Surgical resection margins are routinely reported, but R category assignment lacks global uniformity and is often absent from pathology reports.
The IASLC's proposed "uncertain resection" category has seen minimal adoption, indicating a need for further evidence and dissemination.
Variations in R classification practices highlight challenges in achieving standardized lung cancer staging worldwide.

Keywords:

Complete resection Lung cancer Residual disease Surgery