Bülzebruck H, Krysa S, Bauer E, Probst G, Drings P, Vogt-Moykopf I
Medical Informatics and Biostatistics, Thoracic Clinic, Heidelberg, FRG.
Eur J Cardiothorac Surg. 1991;5(7):356-62. doi: 10.1016/1010-7940(91)90052-l.
For the purpose of testing the validity of the new TNM classification (fourth edition) for lung cancer, data from 1086 patients with surgical treatment were analysed prospectively. Several items were examined: (1) the agreement between clinical (TNM) and pathologically confirmed classification (pTNM); (2) the value of the various diagnostic tests in 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 classification were identical in 64% of the cases. With regard to lymph node involvement (N), the agreement was 48%, for distant metastasis 90% and for the staging 55%. As for the primary tumour (T), the accuracy of radiography (59%) was nearly identical with that of computed tomography (58%). Both these diagnostic techniques were less precise in determining the extent of lymph node involvement (computed tomography 50% correct assessments, radiography 43%). The statistically significant differences in the prognoses for the various pT, pN and pM categories as well as for the pathological stages and the categories of the new R classification could be confirmed. The new 1987 TNM definitions for lung cancer make possible international conformity; the classification is also practically useful and the prognostic relevance improved. The new classifications thus provide a more reliable basis for establishing guidelines for individual oncological therapy strategies and for the exchange of information between different centres on the progress made in diagnosis and therapy of lung cancer.
为检验新版肺癌TNM分类（第四版）的有效性，对1086例行手术治疗患者的数据进行了前瞻性分析。研究了几个项目：（1）临床（TNM）与病理确诊分类（pTNM）之间的一致性；（2）各种诊断检查在评估病理确诊分类中的价值；（3）TNM定义对区分不同预后组的影响。关于原发肿瘤（T），64%的病例临床和病理分类相同。关于淋巴结受累（N），一致性为48%，远处转移为90%，分期为55%。至于原发肿瘤（T），X线摄影的准确性（59%）与计算机断层扫描的准确性（58%）几乎相同。这两种诊断技术在确定淋巴结受累程度方面都不太精确（计算机断层扫描正确评估率为50%，X线摄影为43%）。可以确认不同pT、pN和pM类别以及病理分期和新R分类类别在预后方面的统计学显著差异。1987年新版肺癌TNM定义实现了国际一致性；该分类在实际应用中也很有用，且预后相关性有所提高。因此，新分类为制定个体肿瘤治疗策略指南以及不同中心之间就肺癌诊断和治疗进展进行信息交流提供了更可靠的基础。
