新旧国际肺癌TNM分期的分析与比较

A Comparison and Analysis of Revised1997Non-Small Cell Lung Cancer TNM Staging System with the1987System

目的:分析、评价新的非小细胞肺癌TNM分期方法的优缺点(UICC1997)。方法:对照UICC1987制订的非小细胞肺癌TNM分期方法,复习有关文献,结合临床实际将新、旧分期方法作对比分析。结果:对1997年新修订的非小细胞肺癌TNM分期方法,目前国际上仍存在一些争议,1987的肺癌分期法临床应用效果良好,1997年所做小范围修订,其中有些并不十分恰当。结论:新的非小细胞肺癌分期方法虽不尽完美,但仍不啻为国际统一的权威分期标准。我国肺癌发病率及临床病例数量均居世界前列,理应在临床工作根据不同T、N、M以及影响预后的各种因素,包括新的生物学指标,为在下次修订中能与各国肺癌工作者共同参与、制定出对各期肺癌治疗方案的确定、预后的估计更为准确而合理的分期标准以及能被普遍接受的淋巴引流图。

Objective:To analyze and evaluate the advantages and shortages of the revised1997non-small cell lung cancer(NSCLC)staging system for our Chinese oncologists referring in their clinic practice.Methods:Based on our own clinical experiences,the revised1987and the related references were reviewed.Results:The1997non-small cell lung cancer TNM staging system although has added a very little to the disease staging,many changes have been totally different from that published in1987.There are continuing controversies in the staging system.Conclusion:Before the next revision of staging system,a worldwide effort to collect accurate databases and analyze a variety of T,N.and M prognostic factors as well as the newer biologic factors is required to define more accurately the clinical and pathologic stages of lung cancer ac-cording to prognosis.This approach would allow a more rational consideration of changes in TNM staging.As well,a single universally accepted lymph node map is needed desperately to unify the staging concepts worldwide.Being higher incidence and population of the lung cancer in Chi na,the Chinese oncologists should contribute more for the new NSCLC staging system.