EVALUATION OF THE NEW (1987) TNM CLASSIFICATION FOR THORACIC ESOPHAGEAL TUMORS
EVALUATION OF THE NEW (1987) TNM CLASSIFICATION FOR THORACIC ESOPHAGEAL TUMORS
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DOI：
10.1002/ijc.2910530208
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发表时间：
1993-01-21
影响因子：
6.4
通讯作者：
IIZUKA, T
中科院分区：
文献类型：
--
作者：
KATO, H;TACHIMORI, Y;IIZUKA, T
351例胸段食管癌患者按照新的（1987）TNM分类进行前瞻性分类。62例患者接受了化疗和/或放疗，未进行手术。291例患者行食管切除术，其中139例行颈部、纵隔及腹部淋巴结腺切除术（三野清扫术）。IIB期患者数量少得不自然，IIA期和IIB期3年生存率相似。除IIA期和IIB期外，T、N、M期患者的生存曲线分布良好。N、pN类患者数量与M、pM类患者数量的符合性较差。M1患者的5年生存率（10.5%）太好，提示预后较好的患者混杂。当M1 （LYM）患者被排除在M1之外时，3年生存率降至0.3%。pM1 （LYM）患者行三野剥离术的5年生存率为38.2%。三野区清扫患者的生存率与阳性淋巴结数呈负相关。根据这些结果，我们建议在接下来的TNM分类中进行以下修改：(1)将阶段IIA和阶段IIB合并为阶段II；（二）将颈淋巴结、腹腔淋巴结纳入区域淋巴结，或者将非区域淋巴结转移与内脏转移区分开来；(3)根据淋巴结阳性数将N1分为N1和N2。
A total of 351 patients with thoracic esophageal carcinoma were prospectively classified according to the new (1987) TNM classification. Sixty-two patients received chemotherapy and/or radiotherapy without surgery. Esophagectomy was performed on 291 patients, among whom 139 underwent cervical, mediastinal and abdominal lymph adenectomy (3-field dissection). The number of stage IIB patients was unnaturally small, and the 3-year survival rates of stages IIA and IIB were similar. The survival curves for patients of T, N and M categories distributed well except for those of stages IIA and IIB. Numbers of patients in N and pN categories and those in M and pM categories showed poor coincidence. The 5-year survival rate for M1 patients (10.5%) was too good, which suggested the mingling of patients with rather better prognosis. When M1 (LYM) patients were excluded from M1, the 3-year survival rate fell to 0.3%. The 5-year survival rate for pM1 (LYM) patients who underwent 3-field dissection was 38.2%. Survival rates and numbers of positive nodes showed negative correlation in patients who underwent 3-field dissection. According to these results, we propose the following revision in the next TNM classification: (1) to group stage IIA and stage IIB together to form Stage II; (2) to include cervical and coeliac lymph nodes among the regional lymph nodes, or to designate metastasis in non-regional lymph nodes separately from metastasis in viscera; and (3) to divide N1 into N1 and N2 according to the number of positive lymph nodes.