对鼻咽癌国际抗癌联盟（UICC）分期标准的评价和修改意见

EVALUATION AND REVISION COMMENTS ON THE UICC TNM STAGING CLASSIFICATION OF NASOPHARYNGEAL CARCINOMA(NPC)

本文回顾性分析自１９５８年４月到１９８４年１０月收治的１９３０例初程放疗的鼻咽癌患者的疗效。按照ＵＩＣＣ分期标准，Ｔ＿１Ｎ＿０、Ｔ＿２Ｎ＿０、Ｔ＿３Ｎ＿０和Ｔ＿４Ｎ＿０的５年生存率分别为９４．７％、７７．１％、５９．３％和３８．６％（统计学上有明显差异）。颈转移性淋巴结大小，单侧或双侧，上、下颈或锁骨上区受侵，淋巴结活动或固定有明显不同的预后。根据这些因素，将Ｎ分期分为４级。改变ＵＩＣＣ分期组合，将Ｔ＿（０－２）Ｎ＿１Ｍ＿０列为Ⅱ期，Ｔ＿（０－３）Ｎ＿２Ｍ＿０列为Ⅲ期，把Ｔ＿４或Ｎ＿３组成的Ⅳ期和Ｍ＿１组成的Ⅳ期分别列为Ⅳ＿ａ和Ⅳ＿ｂ期，这样各期病例的分布比例及各期病例预后的差别更能反映实际，也更为合理。

AbstractAseries of 1930 N P C patients treated by radiotherapy in our hospital fromApril, 1958 to October,1984 were retrospectively analyzed to evaluate the criteriaof the TNM staging system on as NPC advised by the UICC. The five year survi-val rates were: 94.7%(T1N0),71.1%(T2N0),59.3%(T3N0) and 38.6%(T4N0),respecti-vely. The size region(ipsilateral or bilateral and upper or lower neck)and movabi-lity of the metastatic lymph nodes could influence the treatment results on NPC.In order to give a appropriate patients distribution and to reflect properly the trea-tment result,we suggest that N(lymph node) be devided into four grades: N0,N1,N2, N3 and N4,and the staging system be divided as follows :stage Ⅰ(T0-1N0M0, stage Ⅱ(T0-2N 1 M0), stageⅢ(T0-3N2M0) stage Ⅳ a(T4, any N or N3,M0)and stage Ⅳb(M1, any T and any N).