Bülzebruck H, Drings P, Kayser K, Schulz V, Tuengerthal S, Vogt-Moykopf I
Thoraxklinik Heidelberg-Rohrbach, Heidelberg, FRG.
Eur Respir J. 1991 Nov;4(10):1197-206.
In January 1987, the 4th edition of the TNM classification for malignant lung tumours by the International Union Cancer (UICC) came into effect. Thus, for the first time, a uniform worldwide staging system for lung cancer became available. In order to validate the new TNM definitions for lung cancer the data of 3,000 patients were analysed prospectively. Several items were examined: 1) the agreement between clinically (TNM) and pathologically (pTNM) confirmed classification; 2) the value of the various diagnostic techniques estimating the pathologically confirmed classification; 3) the influence of the TNM definitions on separating distinct prognostic groups. With regard to the primary tumour (T), clinical and pathological classifications were identical in 64%; for lymph node involvement (N) the agreement was 48%; for distant metastases it was 90% and for the stages it was 55%. As for the primary tumour (T) the accuracy of radiography (59%) was nearly identical to computed tomography (58%). Both techniques were less precise in determining the extent of lymph node involvement (computed tomography 50%, radiography 43%, correct assessments). The statistically significant differences in prognosis for the various T-, N- and M-categories as well as for the stages could be confirmed. By the new 1987 TNM definitions (4th edition) for lung cancer international conformity became feasible as well as practical, and the improvement in its prognostic relevance provided, therefore, a more reliable basis for establishing guidelines for individual oncological concepts of therapy.
1987年1月，国际癌症联盟（UICC）的恶性肺肿瘤TNM分类第4版开始生效。于是，首次出现了一个全球统一的肺癌分期系统。为了验证肺癌新的TNM定义，对3000例患者的数据进行了前瞻性分析。研究了几个项目：1）临床（TNM）和病理（pTNM）确诊分类之间的一致性；2）各种诊断技术对病理确诊分类的评估价值；3）TNM定义对区分不同预后组的影响。关于原发肿瘤（T），临床和病理分类的一致性为64%；关于淋巴结受累（N），一致性为48%；关于远处转移，一致性为90%，关于分期，一致性为55%。至于原发肿瘤（T），X线摄影的准确性（59%）与计算机断层扫描（58%）几乎相同。两种技术在确定淋巴结受累程度方面都不太精确（计算机断层扫描50%，X线摄影43%，正确评估）。可以证实不同T、N和M类别以及分期在预后方面的统计学显著差异。通过1987年肺癌新的TNM定义（第4版），国际一致性变得可行且实用，其预后相关性的改善因此为制定个体肿瘤治疗概念的指南提供了更可靠的基础。
