Feinstein A R, Sosin D M, Wells C K
N Engl J Med. 1985 Jun 20;312(25):1604-8. doi: 10.1056/NEJM198506203122504.
We found that a cohort of patients with lung cancer first treated in 1977 had higher six-month survival rates for the total group and for subgroups in each of the three main TNM stages (tumor, nodes, and metastases) than a cohort treated between 1953 and 1964 at the same institutions. The more recent cohort, however, had undergone many new diagnostic imaging procedures. According to the "old" diagnostic data for both cohorts, the recent cohort had a prognostically favorable "zero-time shift." In addition, by demonstrating metastases that had formerly been silent and unidentified, the new technological data resulted in a stage migration. Many patients who previously would have been classified in a "good" stage were assigned to a "bad" stage. Because the prognosis of those who migrated, although worse than that for other members of the good-stage group, was better than that for other members of the bad-stage group, survival rates rose in each group without any change in individual outcomes. When classified according to symptom stages that would be unaltered by changes in diagnostic techniques, the two cohorts had similar survival rates.
我们发现，1977年首次接受治疗的一组肺癌患者，与1953年至1964年期间在同一机构接受治疗的一组患者相比，总体组以及三个主要TNM分期（肿瘤、淋巴结和转移）中每个亚组的六个月生存率更高。然而，最近的这组患者接受了许多新的诊断成像程序。根据两组患者的“旧”诊断数据，最近的这组患者有一个预后良好的“零时间偏移”。此外，新技术数据通过显示以前未被发现的隐匿转移灶，导致了分期迁移。许多以前会被归类为“良好”分期的患者被重新归类为“不良”分期。由于那些分期迁移的患者的预后虽然比“良好”分期组的其他成员差，但比“不良”分期组的其他成员好，所以每组的生存率都有所提高，而个体结局没有任何变化。当根据不受诊断技术变化影响的症状分期进行分类时，两组患者的生存率相似。
