Mountain C F
Yale J Biol Med. 1981 May-Jun;54(3):161-72.
The morphology of the tumor and the anatomic extent of the disease are important factors influencing treatment selection and ultimately survival for patients with lung cancer. The American Joint Committee TNM system provides a method for consistent reproducible description of the primary tumor (T), the status of the regional lymph nodes (N), and the presence or absence of distant metastasis (M). The TNM subsets thus classified can be grouped into three "stages" of disease such that the survival expectations for patients in each stage and cell type are similar. This classification of patients with respect to estimates of their prognosis is essential for valid comparisons of treatment modalities and meaningful communication of end results information.Clinical characteristics which influence survival are reflected in the staging recommendations. The size of the lesion, the proximal margination, and the presence or absence of other pulmonary complications are features which distinguish the T classification as T1, T2, or T3. The presence or absence of lymph node involvement has an important bearing on survival expectations. Advancing from no nodal involvement, N0, to involvement of the peribronchial and hilar nodes, N1, and then to the mediastinal nodes, N2, causes progressive erosion in survival expectations. The tumor morphology and specific nodes that are involved are important components of this relationship. The presence of distant metastasis, M1, is synonymous with an extremely poor prognosis. Using these prognostic elements, the TNM subsets are combined into three stages of disease so that patients in each group will have a generally similar life expectancy, the survival for patients with stage I disease being significantly greater than that for patients with stage II disease which is significantly greater than survival for patients with stage III disease.Improvements in the outcome for lung cancer patients depend upon the depth and scope of our scientific understandings and our ability to communicate our observations to one another. Measures of response to treatment can be translated into therapeutic practice only if uniform evaluators are used. Accordingly, a reproducible valid system for staging of lung cancer is recommended.
肿瘤形态和疾病的解剖范围是影响肺癌患者治疗选择及最终生存的重要因素。美国联合委员会的TNM系统提供了一种方法，可对原发肿瘤（T）、区域淋巴结状态（N）以及远处转移的有无（M）进行一致且可重复的描述。如此分类的TNM亚组可分为疾病的三个“阶段”，使得每个阶段和细胞类型患者的生存预期相似。这种根据患者预后估计进行的分类，对于有效比较治疗方式以及有意义地交流最终结果信息至关重要。影响生存的临床特征反映在分期建议中。病变大小、近端切缘以及其他肺部并发症的有无是区分T分类为T1、T2或T3的特征。淋巴结受累与否对生存预期有重要影响。从无淋巴结受累（N0）发展到支气管周围和肺门淋巴结受累（N1），再到纵隔淋巴结受累（N2），会导致生存预期逐渐降低。肿瘤形态和受累的特定淋巴结是这种关系的重要组成部分。远处转移（M1）的存在意味着预后极差。利用这些预后因素，TNM亚组被合并为疾病的三个阶段，以便每组患者的预期寿命大致相似，I期疾病患者的生存率显著高于II期疾病患者，而II期疾病患者的生存率又显著高于III期疾病患者。肺癌患者治疗结果的改善取决于我们科学理解的深度和广度，以及我们相互交流观察结果的能力。只有使用统一的评估者，治疗反应的测量结果才能转化为治疗实践。因此，推荐一种可重复且有效的肺癌分期系统。
