[Controversy over the UICC-TNM classification].
The new UICC-TNM classification is accepted by most thoracic surgeons and medical oncologists because the prognosis of lung cancer patients is well distinguished by stage based on the TNM classification. However, there are several controversies over improving the classification. The number of small-sized peripheral lung cancers detected by helical computed tomography screening is rapidly increasing in Japan. The prognosis for patients with these tiny lung cancers is extremely good. Therefore, these lung cancers should be separated from T1 lung cancers detected by conventional chest X-ray. T2 includes a wide range of tumor sizes. The prognosis of T3 disease is different depending on the organs invaded. T4 disease is a contraindication for surgery, although some T4 cases could undergo complete resection and be cured. T4 disease should therefore be divided into operable T4 and inoperable T4. The most important controversy over the N factor is the boundary between N1 and N2 because of the lack of a universally common map of lymph node stations. Classification of satellite nodules is another controversy. Most proposals by Japanese surgeons are based on postoperative pathological TNM classification and staging. Pathological classification indicates postoperative prognosis well. Prognostic analysis based on clinical classification indicates postoperative prognosis well. Prognostic analysis based on clinical classification is needed to determine the strategy for each patient.
Tsuchiya
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Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan.
D006801:Humans; D007390:International Agencies; D008175:Lung Neoplasms / Q000145:classification*; D011379:Prognosis