Grunenwald D
Département thoracique, Institut mutualiste Montsouris, Paris, France.
Cancer Radiother. 1998 Sep-Oct;2(5):568-73. doi: 10.1016/s1278-3218(98)80089-9.
According to the TNM staging system for lung cancers, stage III is divided into IIIA and IIIB. This division was based upon the principle that patients with IIIA disease could theoretically benefit from complete resection, contrasting with IIIB patients for whom surgery is not feasible. The poor prognosis of stage IIIB is largely due to its classical inoperability. From the surgical point of view, stage IIIB can be subdivided into four subgroups: 1) N3 where resection is possible in selected patients through median sternotomy; 2) T4 where extended surgery can be considered in selected patients; 3) N3 + T4; 4) malignant pleural or pericardial effusion contraindicating any radical surgery. Criteria for resectability could be defined to include some IIIB patients in multimodality protocols in which surgery would become possible after induction therapy: definitive inoperability excludes any possibility of surgery, even in cases in which radiotherapy alone or combined with chemotherapy leads to complete remission; immediate inoperability allows patients to be included in protocols evaluating induction treatments designed to render tumours resectable.
根据肺癌的TNM分期系统，Ⅲ期分为ⅢA和ⅢB期。这种划分基于这样的原则，即理论上ⅢA期疾病患者可从完全切除中获益，这与ⅢB期患者不同，ⅢB期患者无法进行手术。ⅢB期预后较差主要是由于其典型的不可切除性。从手术角度来看，ⅢB期可细分为四个亚组：1）N3，部分患者可通过正中胸骨切开术进行切除；2）T4，部分患者可考虑进行扩大手术；3）N3+T4；4）恶性胸腔或心包积液，提示无法进行任何根治性手术。可切除性标准可定义为在多模式治疗方案中纳入部分ⅢB期患者，在诱导治疗后这些患者有可能进行手术：明确的不可切除性排除了任何手术可能性，即使单独放疗或放化疗联合治疗导致完全缓解的情况；即刻不可切除性允许患者纳入评估诱导治疗的方案，诱导治疗旨在使肿瘤可切除。
