Shepherd Frances A, Crowley John, Van Houtte Paul, Postmus Pieter E, Carney Desmond, Chansky Kari, Shaikh Zeba, Goldstraw Peter
Department of Medicine, Division of Medical Oncology and Hematology of the University Health Network, Princess Margaret Hospital and the University of Toronto, Ontario, Canada.
J Thorac Oncol. 2007 Dec;2(12):1067-77. doi: 10.1097/JTO.0b013e31815bdc0d.
Small cell lung cancer (SCLC) is usually classified using the limited and extensive definition. The tumor, node, metastasis (TNM) classification should also be applicable to SCLC, but it has only been reported in small surgical series. The current analysis looks to the impact of the TNM system on the clinical staging of SCLC and of the new International Association for the study of Lung Cancer (IASLC) proposals.
Using the IASLC database, survival analyses were performed for clinically staged patients. Prognostic groups were compared, and the new IASLC TNM proposals were applied to this population and to the Surveillance, Epidemiology, and End Results (SEER) database.
The IASLC database contained 12,620 eligible cases of small cell histology. TNM staging was available for 8088 patients. Survival was directly correlated to both T and N category. Differences were more pronounced in patients without mediastinal or supraclavicular nodal involvement. Stage grouping using the sixth edition of TNM also differentiates survival except between IA and IB. Patients with pleural effusion regardless of the cytology have an intermediate prognosis between limited and extensive disease. The IASLC proposals for the seventh edition of the TNM classification also apply to this series of SCLC and to the SEER database.
TNM staging is recommended for SCLC, and stratification by stage I-III should be incorporated in clinical trials of early-stage disease. Further studies are needed to clarify the impact of pleural effusion and the extent of N3 disease.
小细胞肺癌（SCLC）通常根据局限期和广泛期的定义进行分类。肿瘤、淋巴结、转移（TNM）分类也应适用于SCLC，但仅在小型手术系列中有报道。本分析旨在探讨TNM系统对SCLC临床分期以及国际肺癌研究协会（IASLC）新提议的影响。
利用IASLC数据库对临床分期患者进行生存分析。比较预后组，并将IASLC新的TNM提议应用于该人群以及监测、流行病学和最终结果（SEER）数据库。
IASLC数据库包含12620例符合条件的小细胞组织学病例。8088例患者有TNM分期信息。生存与T和N类别直接相关。在无纵隔或锁骨上淋巴结受累的患者中差异更为明显。使用第六版TNM进行分期分组也能区分生存情况，除了IA期和IB期之间。无论细胞学检查结果如何，有胸腔积液的患者预后介于局限期和广泛期之间。IASLC关于TNM分类第七版的提议也适用于这一系列SCLC以及SEER数据库。
推荐对SCLC进行TNM分期，并且在早期疾病的临床试验中应纳入I - III期分层。需要进一步研究以阐明胸腔积液的影响以及N3期疾病的范围。
