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J Thorac Cardiovasc Surg 1998;116:407-411
© 1998 Mosby, Inc.
General Thoracic Surgery |
Supported by grants of the Ministry of Education, Science, Sports, andCulture, Japan.
Received for publication Jan 2, 1998; revisions requested March 26,1998; revisions received April 23, 1998; accepted for publication May 20, 1998. Address for reprints: Kunihiko Inoue, MD, Department of ThoracicSurgery, Institute of Development, Aging and Cancer Tohoku University, Sendai,Japan.
Objective: The TNM staging system of lungcancer is widely used as a guide for estimating prognosis and selectingtreatment modality. In 1997, the International Union Against Cancer and theAmerican Joint Committee on Cancer have adopted a revised stage grouping forlung cancer. However, the validity of the new stage grouping has not been fullyestablished. We investigated the prognoses of patients who had resection of nonsmall-celllung cancer to confirm the validity of the revised classification.
Methods: A total of 1310 patients with nonsmall-celllung cancer underwent complete resection and pathologic staging of the diseasein our hospitals from 1980 through 1993. A pulmonary resection was performedwith a systematic nodal dissection. The survivals were calculated with theKaplan-Meier method on the basis of overall deaths, and the survival curves werecompared by log rank test.
Results: Therewere significant differences in survival between patients with T1 N0 M0 and T2N0 M0 disease and between those with T1 N1 M0 and T2 N1 M0 disease. However,there was no significant difference between patients with T2 N0 M0 disease andthose with T1 N1 M0 disease. No significant difference in survival was observedamong patients with T2 N1 M0, T3 N0 M0, and T3 N1 M0 cancer. Patients withdifferent invaded organs of T3 subdivision (pleura, chest wall, pericardium, ordiaphragm) had a different prognosis. There was no significant differencebetween patients with T3 N2 M0 disease and those with stage IIIB disease.
Conclusions: We supported most of the revision, such asdividing stage I, dividing stage II, and putting T3 N0 M0 to stage IIB.Furthermore, we found some candidates for a subsequent revision, such as puttingT3 N1 M0 to stage IIB, putting T2 N0 M0 and T1 N1 M0 together, regardingdiaphragm invasion as T4, and putting T3 N2 M0 to stage IIIB. (J ThoracCardiovasc Surg 1998;116:407-11)
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