Thoracic Surgery Unit, University of Novara, Novara, Italy.
Cancer J. 2010 Mar-Apr;16(2):176-81. doi: 10.1097/PPO.0b013e3181ce474e.
PURPOSE: To evaluate the utility of the proposals of the International Association for the Study of Lung Cancer (IASLC) in the forthcoming 7th edition of lung cancer staging system to classify patients submitted to radical surgical resection of non-small cell lung cancer and to compare their value in predicting long-term prognosis with the existing 6th edition of the American Joint Committee on Cancer (AJCC)/Union Internationale Contre le Cancer (UICC) TNM classification. METHODS: Nine hundred twenty-one patients received an anatomic resection and hilar-mediastinal dissection for primary non-small cell lung cancer during the period 1990 to 2005. Histopathologic staging following the actual AJCC/UICC TNM classification were as follows: 207 T1, 562 T2, 148 T3, and 4 T4; 570 N0, 149 N1, 198 N2, and 4 N3; 163 stage IA, 346 IB, 23 IIA, 157 IIB, 224 IIIA, and 8 IIIB. Stages reclassified using the proposals of IASLC for the new staging system were as follows: 101 T1a, 106 T1b, 400 T2a, 103 T2b, 210 T3, and 1 T4; 163 stage IA, 262 IB, 157 IIA, 106 IIB, 230 IIIA, and 4 IIIB. RESULTS: Follow-up was obtained for 836 patients. Mean follow-up was 46.5 +/- 48.9 months. N-status (unchanged between the 2 classifications) was confirmed to be a significant prognostic factor. Significant differences in 10-year disease-related survival were demonstrated between stages IIB and IIIA only (35% vs 14%) of the AJCC/UICC TNM classification and between stages IB and IIA (60% vs 46%) and stages IIB and IIIA (39% vs 15%) of the IASLC proposals for a new classification. DISCUSSION: The proposals of IASLC in the forthcoming 7th edition of the lung cancer staging system are demonstrated to be better able to separate prognostically distinct groups of patients operated for non-small cell lung cancer than the accepted existing 6th AJCC/UICC TNM classification.
目的：评估国际肺癌研究协会（IASLC）在即将到来的第 7 版肺癌分期系统中的建议，以对接受非小细胞肺癌根治性手术的患者进行分类，并比较其在预测长期预后方面的价值与现有的第 6 版美国癌症联合委员会（AJCC）/国际抗癌联盟（UICC）TNM 分类。
方法：1990 年至 2005 年间，921 例原发性非小细胞肺癌患者接受了解剖性肺切除术和肺门纵隔廓清术。根据实际的 AJCC/UICC TNM 分类进行组织病理学分期如下：207 例 T1，562 例 T2，148 例 T3 和 4 例 T4；570 例 N0，149 例 N1，198 例 N2 和 4 例 N3；163 例 IA，346 例 IB，23 例 IIA，157 例 IIB，224 例 IIIA 和 8 例 IIIB。使用 IASLC 对新分期系统的建议重新分类的分期如下：101 例 T1a，106 例 T1b，400 例 T2a，103 例 T2b，210 例 T3 和 1 例 T4；163 例 IA，262 例 IB，157 例 IIA，106 例 IIB，230 例 IIIA 和 4 例 IIIB。
结果：对 836 例患者进行了随访。平均随访时间为 46.5+/-48.9 个月。N 分期（在两种分类之间没有变化）被证实是一个重要的预后因素。仅在 AJCC/UICC TNM 分类的 IIB 期和 IIIA 期（35%比 14%）以及 IASLC 新分类的 IB 期和 IIA 期（60%比 46%）和 IIB 期和 IIIA 期（39%比 15%）之间显示出 10 年疾病相关生存率的显著差异。
讨论：即将到来的第 7 版肺癌分期系统中的 IASLC 建议被证明比现有的第 6 版 AJCC/UICC TNM 分类更能将接受非小细胞肺癌手术的患者分为预后不同的组。
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