Miller J D, Gorenstein L A, Patterson G A
Department of Surgery, Toronto Hospital, Ontario, Canada.
Ann Thorac Surg. 1992 Jan;53(1):170-8.
Staging is the quantitative assessment of malignant disease and allows logical groupings of patients with a similar extent of disease for prognostic, therapeutic, and analytic purposes. In bronchogenic carcinoma a stage is assigned based on size, location, and the extent of invasion of the primary tumor, as well as the presence of any regional or metastatic disease. Selecting the most appropriate treatment for a patient with bronchogenic carcinoma depends on precise staging. The extent of local invasion and presence of metastatic disease will determine the likelihood of complete resection and possible cure. Careful assessment of the history, blood chemistry, radiographic studies, bronchoscopy, mediastinoscopy, and exploration (thoracotomy) are all important staging tools. Routine radionuclide scans have no useful role when there is no clinical or laboratory evidence of metastases. The T status of a tumor is best judged by bronchoscopy and at thoracotomy. Thoracic surgeons must be familiar with the techniques available to determine T status intraoperatively and use this information when planning resection. Computed tomography of the chest has fallen short in predicting direct invasion of the mediastinum and chest wall. Cervical and anterior mediastinoscopy remain important tools in determining operability. Intraoperative assessment of node involvement determines the extent of resection and likelihood of cure.
分期是对恶性疾病的定量评估，它能根据疾病程度对患者进行合理分组，以用于预后、治疗及分析目的。在支气管源性肺癌中，分期是基于原发肿瘤的大小、位置、浸润范围以及是否存在任何区域或转移性疾病来确定的。为支气管源性肺癌患者选择最合适的治疗方法取决于精确的分期。局部浸润范围和转移性疾病的存在将决定能否完全切除以及治愈的可能性。仔细评估病史、血液化学指标、影像学检查、支气管镜检查、纵隔镜检查和探查（开胸手术）都是重要的分期手段。当没有临床或实验室证据表明存在转移时，常规放射性核素扫描没有实际作用。肿瘤的T分期最好通过支气管镜检查和开胸手术来判断。胸外科医生必须熟悉术中确定T分期的可用技术，并在规划切除手术时利用这些信息。胸部计算机断层扫描在预测纵隔和胸壁的直接浸润方面存在不足。颈部和前纵隔镜检查仍然是确定可手术性的重要手段。术中对淋巴结受累情况的评估决定了切除范围和治愈的可能性。
