Mountain C F
Surg Clin North Am. 1987 Oct;67(5):925-35. doi: 10.1016/s0039-6109(16)44330-6.
The International Staging System for Lung Cancer provides for classification of six levels of disease extent in five stage groups that relate to patient management and prognosis. Stage 0 is reserved for patients with carcinoma in situ. The Stage I and II definitions provide for classification of two levels of disease extent completely contained within the lung that have different prognostic and therapeutic implications. Definitive resection is the first choice of therapy for patients with non-small cell lung cancer in these stage groups. The Stage II category takes into account the erosion of survival expectations in the optimum group of T1 and T2 patients as a consequence of intrapulmonary lymph node involvement. Although small cell carcinoma is infrequently encountered as Stage I and Stage II disease, these classifications may be useful in the structure of investigational programs involving adjuvant surgery. The exclusion of distant metastases and the division of Stage III into two levels of extrapulmonary disease allow for selection of patients for specific treatment plans. Patients with non-small cell tumors with Stage IIIa disease usually are candidates for definitive surgical treatment. The specificity of the T and N definitions in the Stage IIIa and IIIb categories identifies patients for whom particular radiotherapy treatment plans are structured and protocol assignments are made. It is consistent with patient management concepts that all those with distant metastases are classified as having Stage IV disease. Implications of the system for selection of surgical, radiotherapeutic, and chemotherapeutic regimens are rational for all cell types. The classification meets the requirement for simplicity and can be readily applied in a broad spectrum of clinical and teaching environments. It is, however, sufficiently specific to be useful for reporting results of investigational therapies. Prospective use of the classification should encourage precision in clinical evaluations that exploit full use of refinements in imaging technologies. The cooperative efforts of the Task Force on Lung of the AJCC and the TNM Committees of the UICC to bring this classification system to fruition and international acceptance have been described. It has been adopted by these groups and others, including the International Association for the Study of Lung Cancer, the Japanese Cancer Committee, and the Spanish Society of Respiratory Disease, as their official recommendation for staging lung cancer.
肺癌国际分期系统针对五个分期组中的六个疾病范围级别进行分类，这些分期组与患者管理及预后相关。0期专为原位癌患者保留。I期和II期的定义针对完全局限于肺内的两个疾病范围级别进行分类，这两个级别具有不同的预后和治疗意义。对于这些分期组中的非小细胞肺癌患者，根治性切除是首选治疗方法。II期类别考虑到T1和T2最佳组患者因肺内淋巴结受累而导致生存预期的降低。虽然小细胞癌很少以I期和II期疾病出现，但这些分类在涉及辅助手术的研究项目结构中可能有用。排除远处转移并将III期分为两个肺外疾病级别，有助于选择适合特定治疗方案的患者。患有IIIa期疾病的非小细胞肿瘤患者通常是根治性手术治疗的候选人。IIIa期和IIIb期类别中T和N定义的特异性，确定了那些制定特定放疗治疗方案和方案分配的患者。所有有远处转移的患者都被分类为IV期疾病，这与患者管理概念一致。该系统对手术、放疗和化疗方案选择的影响对所有细胞类型都是合理的。该分类满足简单性要求，可在广泛的临床和教学环境中轻松应用。然而，它也足够具体，可用于报告研究性治疗的结果。该分类的前瞻性使用应鼓励在临床评估中更加精确，充分利用成像技术的改进。美国癌症联合委员会（AJCC）肺癌特别工作组与国际抗癌联盟（UICC）TNM委员会为使该分类系统得以实现并获得国际认可而进行的合作努力已被描述。该系统已被这些组织以及其他组织，包括国际肺癌研究协会、日本癌症委员会和西班牙呼吸疾病学会，采纳为肺癌分期的官方推荐。
