RESULTS OF PNEUMONECTOMY FOR NONSMALL CELL LUNG-CANCER - APPROPRIATENESS OF THE NEW TNM STAGING SYSTEM

In the new TNM staging system for lung cancer in 1997, stage T3N0M0 wa s revised from stage IIIA. to stage IIB. Therefore, we initiated a stu dy to assess the appropriateness of this revision. One hundred and nin eteen patients who had undergone pneumonectomy for non-small cell lung cancer (NSCLC) between January 1985 and March 1996 were analyzed. The y included 87 squamous cell carcinoma (sq), 25 adenocarcinoma (ad), 4 large cell carcinoma (la), and 3 adenosquamous cell carcinoma (ad-sq), with 10 patients in post operative stage I (3 IA + 7 IB), 29 stage II (1 IIA + 28 IIB), 74 stage III (39 IIIA + 35 IIIB) and 6 in stage IV of the disease. Stage IIB included 14 patients with T3N0M0 (12 sq, 1 a d, 1 la). The 5-year survival rate for patients with T3NOMO was 69.6%, which was superior to that (55.7%) for patients with stage II (T1-2N1 M0) of the previous system. According to the new TNM staging system, t he 5-year survival rate was 40% in stage I, 66.2% in stage II, 24% in stage IIIA, 0% in stages IIIB and IV (stage I vs stage II, NS; stage I I vs stage IIIA, p<0.01; stage IIIA vs stage IIIB, p<0.01; stage IIIB vs stage IV, p<0.01). A significant prognostic difference between stag e II and stage IIIA was observed, which had not been observed in the p revious system. Our results show that the revision of T3N0M0 from stag e IIIA to stage II in the new TNM staging system seems appropriate wit h regard to the pneumonectomy group.