Motta G, Nahum M A, Testa T, Spinelli E
Università degli Studi di Genova, Cattedra di Patologia Chirurgica.
Ann Ital Chir. 1995 Jul-Aug;66(4):425-32.
The TNM System as originally proposed by Denoix in 1946, provides a consistent, reproducible description of the anatomic extent of disease in cancer patients at a specific time in the life history of the cancer. C.F. Mountain first adapted this classification to lung cancer in 1973 on behalf of AJCC. In 1986 he presented the "New Intl. Staging System for Lung Cancers" mainly based on a 13 yr experience of the previous one, which was accepted world-wide through a round of international consensus meetings held in 1985. Clinical Staging is the best estimate of disease extent made prior to the institution of any therapy; Surgical-pathological Staging is the classification of disease extent as determined from pathological examination of resected specimens. Accordingly, once the diagnosis is made, it is necessary to stage accurately the tumour determining the size and location of the tumour (T status), the presence or absence of lymphnode involvement (N status), and whether the tumour is metastatic to distant sites (M status). Moreover the uniform staging criteria for lung cancer will assure for each patient the better selection of treatment, the evaluation of operability, the need for adjuvant therapy, as well as the estimation of prognosis. Equally important is the resultant ability to compare the outcome of treatment protocols from different centres. More recently C.F. Mountain has added to the Staging System a new standard logic or "convention" for classifying infrequently observed presentations of lung cancer with which the standard rules of Staging System itself don't fit. These conventions are based on empiric expectation for treatment selection and survival that are similar to those for the Staging definitions, which are based on actuarialsurvival data. Many different types of tumour such as multiple masses, synchronous multiple primitives, discontinuous tumour foci in visceral or parietal pleura as well neoplastic involvement of various mediastinal structures, could be now staged with a major benefit for their treatment protocols. In conclusion the Staging System represents today a standard clinical methodology which basically helps in a better clinical approach to lung cancer even if it cannot fully cover and consider all the innumerable manifestations of the tumor. Therefore, if it is true that in the near future the new molecular predictors of prognosis are expected to measure more deeply the extent of disease, for the present time the International Staging System still continues to act as the best common method for measuring prognosis.
1946年由德诺瓦最初提出的TNM系统，对癌症患者在癌症病程特定时间的疾病解剖范围提供了一致、可重复的描述。1973年，C.F. 芒廷代表美国癌症联合委员会首次将该分类法应用于肺癌。1986年，他提出了“肺癌新国际分期系统”，主要基于此前13年的经验，该系统在1985年召开的一轮国际共识会议后被全球接受。临床分期是在任何治疗开始前对疾病范围的最佳评估；手术病理分期是根据切除标本的病理检查确定的疾病范围分类。因此，一旦做出诊断，就有必要准确地对肿瘤进行分期，确定肿瘤的大小和位置（T状态）、是否存在淋巴结受累（N状态）以及肿瘤是否转移至远处部位（M状态）。此外，肺癌统一的分期标准将确保为每位患者更好地选择治疗方法、评估手术可行性、确定辅助治疗的必要性以及估计预后。同样重要的是，由此能够比较不同中心治疗方案的结果。最近，C.F. 芒廷在分期系统中增加了一种新的标准逻辑或“惯例”，用于对肺癌中不常见的表现进行分类，而分期系统本身的标准规则并不适用于这些表现。这些惯例基于对治疗选择和生存的经验性预期，与基于精算生存数据的分期定义的预期相似。现在，许多不同类型的肿瘤，如多个肿块、同步多发原发性肿瘤、脏层或壁层胸膜中的不连续肿瘤灶以及各种纵隔结构的肿瘤累及，都可以进行分期，这对其治疗方案有很大益处。总之，分期系统如今代表了一种标准的临床方法，即使它不能完全涵盖和考虑肿瘤的所有无数表现，基本上也有助于更好地临床处理肺癌。因此，如果在不久的将来新的预后分子预测指标有望更深入地衡量疾病范围这一点是正确 的，那么目前国际分期系统仍然继续作为衡量预后的最佳通用方法。
