Miyazawa M, Shiina T, Kurai M, Makiuchi A, Numanami H, Kondo R, Takasuna K, Machida E, Hanaoka T, Yoshida K, Kaneko K, Yamanda T, Haniuda M, Amano J
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Kyobu Geka. 2000 Oct;53(11):915-8.
To evaluate the revised TNM classification, we investigated the prognoses of 552 consecutive patients who had resection of non-small-cell lung cancer between April 1982 and March 1996. According to the new classification, the 5-year survival rate was 76.9% for stage I A, 57.2% for stage I B (I A versus I B, p < 0.0005), 47.7% for stage IIA, 49.8% for stage IIB, 18.6% for stage IIIA (IIB versus IIIA, p = 0.005), 16.7% for stage IIIB, and 7.9% for stage IV (IIIB versus IV, p = 0.02). Especially for patients in stage I A, there was significant difference in survival between patients with the tumor size within 1.5 cm and those with larger than 1.5 cm. The survival rate for T3N0M0 patients was significantly better than that for T3N1-2M0, but there was no significant difference between patients with T3N0M0 disease and those with T2N1M0 disease. Concerning the pm1 patients, the survival rate was significantly better than other stage IIIB patients. Our results supported the revision for dividing stage I and putting T3N0M0 into stage IIB. However, the classification is controversial about dividing stage II and putting pm1 as T4 disease. Furthermore, subgrouping of T1N0M0 disease by tumor size, T3 by tumor invaded organ will be necessary in the next revisions.
为评估修订后的TNM分类，我们调查了1982年4月至1996年3月期间连续552例行非小细胞肺癌切除术患者的预后情况。根据新分类，ⅠA期患者的5年生存率为76.9%，ⅠB期为57.2%（ⅠA期与ⅠB期比较，p<0.0005），ⅡA期为47.7%，ⅡB期为49.8%，ⅢA期为18.6%（ⅡB期与ⅢA期比较，p = 0.005），ⅢB期为16.7%，Ⅳ期为7.9%（ⅢB期与Ⅳ期比较，p = 0.02）。特别是对于ⅠA期患者，肿瘤大小在1.5 cm以内的患者与大于1.5 cm的患者生存率存在显著差异。T3N0M0患者的生存率显著优于T3N1 - 2M0患者，但T3N0M0患者与T2N1M0患者之间无显著差异。关于pm1患者，其生存率显著优于其他ⅢB期患者。我们的结果支持将Ⅰ期进行细分并将T3N0M0归入ⅡB期的修订。然而，关于将Ⅱ期细分并将pm1归为T4期疾病的分类存在争议。此外，在下次修订中，有必要根据肿瘤大小对T1N0M0疾病进行亚组划分，根据肿瘤侵犯器官对T3进行亚组划分。
