肺癌的临床分期与外科病理TNM分期比较

Comparison of clinical and surgico-pathological TNM stage of 2007 lung cancer patients

目的分析对比肺癌患者术前临床分期(c-TNM)及术后外科病理分期(p-TNM),评价c-TNM的准确度及其对制定肺癌外科治疗方案的意义。方法回顾性分析对比2007例肺癌患者的c-TNM和p-TNM。术前检查包括常规体检、化验室检查、胸部X线、胸及上腹部CT、必要的痰细胞学检查、支气管镜检查、腹部B超检查、骨扫描、脑CT和(或)MRI以及纵隔镜检查活检等。结果2007例肺癌患者c-TNM及p-TNM的总符合率为39.0%。对于全组患者病变,临床估计过低者为45.2%,估计过高者为15.8%。在全部c-TNM期中,1105例c-ⅠA或c-ⅠB期的临床低估率最高,达55.2%。T亚组的临床分期较易,总准确率为72.9%;N亚组的临床分期较难,总准确率为53.5%。分析表明,c-Ⅳ期并非为外科治疗的绝对禁区,因为有一半患者由术前的c-M1期转化为术后的p-M0期,从而有可能在T和N许可的情况下为手术治疗提供机会。结论目前的术前临床TNM分期仍然是一种粗糙的评定,其原因有待探讨,其准确性有待进一步提高。

Objective An accurate clinical TNM staging of lung cancer is essential for the precise determination of the extent of the disease in order that an optimal therapeutic strategy can be planned. This is especially true in patients with marginally resectable tumors. Clinical over-staging of the disease may deny a patient the benefit of surgery, whereas under-staging may oblige a patient to accept a fruitless or even harmful surgery. We aimed to analyze preoperative clinical （ c-TNM ） and postoperative surgico-pathologic staging （p-TNM） of lung cancer patients in order to evaluate the accuracy of our clinical staging and its implications on the surgical strategy for lung cancer. Methods We did a retrospective comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer surgically treated from January 1999 to May 2003. Preoperative evaluation and c-TNM staging of all patients were based on physical examination, laboratory studies, routine chest X-ray and CT scan of the chest and upper abdomen. Other examinations included sputum cytology, bronchoscopy, abdominal uhrasonography, bone scintiscan, brain CT/MRI, and mediastinoscopy whenever indicated. Results In the present study the comparison of c-TNM and p-TNM staging of 2007 patients with lung cancer revealed an overall concurrence rate of only 39.0%. In the entire series the extent of disease was clinically underestimated in 45.2% and overestimated in 15.8% of the patients. Among all c-TNM stages the c-IA/B stage of 1105 patients gave the highest rate （55.2%） of underestimating the extent of disease. Clinical staging of T subsets was relatively easy with an overall accuracy rate of 72.9% , while that of N subsets was relatively more difficult with an overall accuracy rate of 53.5%. Analysis also showed that c-Ⅳ stage may not be an absolute contraindication to surgery, because in half of the patients, c-M1 turned out to be p-MO, providing the possibility of resectional surgery depending on the status of T and N. Conclusion For reasons to be further determined, the present preoperative clinical TNM staging of lung cancer remains a crude evaluation. Further efforts to improve its accuracy are needed.