NCCN Guidelines Version 3.2017 NCCN指南2017第3版

Non-Small Cell Lung Cancer
非小细胞肺癌山东省肿瘤医院呼吸肿瘤内科张品良

Discussion
讨论

Staging
分期

A new edition of the AJCC Cancer Staging Manual (8th edition) was published in late 2016 and will be effective for all cancer cases recorded on or after January 1, 2018. The NCCN Guidelines will use the AJCC (7th edition) staging system for lung cancer until January 1, 2018. The definitions for TNM and the stage grouping are summarized in Tables 1 and 2 of the staging tables (see Definitions for T,N,M and Staging in the NCCN Guidelines for NSCLC). The descriptors of the TNM classification scheme are summarized in Table 3 of the staging tables (see Staging). The lung cancer staging system was revised by the International Association for the Study of Lung Cancer (IASLC). And was adopted by the AJCC. With the AJCC staging, locally advanced disease is stage III; advanced disease is stage IV. Pathologic staging uses both clinical staging information (which is noninvasive and includes medical history, physical examination, and imaging) and other invasive staging procedures (eg, thoracotomy, examination of lymph nodes using mediastinoscopy).
新版AJCC癌症分期手册（第8版）已在2016年底出版，将在2018年1月1日或以后的所有癌症病例记录中实施。NCCN指南使用的AJCC （第7版） 肺癌分期系统将在2018年1月1日终止。TNM定义、分期组合总结在分期表1和2（见非小细胞肺癌NCCN指南中的T、N、M及分期定义）。TNM分期组合描述总结在分期表中的表3（见分期）。肺癌分期系统由国际肺癌研究协会（IASLC）修订。并被AJCC采用。对于AJCC分期，局部晚期疾病是III期；晚期疾病是IV期。病理分期使用临床分期信息（为无创性，包括病史、体格检查与影像学）和其他侵袭性分期措施（如开胸术、纵隔镜淋巴结检查）两者的信息。

From 2006 to 2012, the overall 5-year relative survival rate for lung cancer was 17.7% in the United States. Of lung and bronchial cancer cases, 16% were diagnosed while the cancer was still confined to the primary site; 22% were diagnosed after the cancer had spread to regional lymph nodes or directly beyond the primary site; 57% were diagnosed after the cancer had already metastasized; and for the remaining 5% the staging information was unknown. The corresponding 5-year relative survival rates were 55% for localized, 28% for regional, 4.3% for distant, and 7.4% for unstaged. However, these data include SCLC, which has a poorer prognosis.
从2006年到2012年，美国肺癌的5年总生存率为17.7%。在肺和支气管癌的病例中，有16%在癌症仍局限于原发部位时被确诊；22%是在癌症已经扩散到区域淋巴结或直接超出了原发部位后确诊；57%是在癌症已经转移后确诊；其余的5%分期信息不明。相应的5年相对生存率是局部55%、区域28%、远处4.3%、未分期7.4%。然而，这些数据包括预后较差的小细胞肺癌。

Five-year survival after lobectomy for pathologic stage I NSCLC ranges from 45% to 65%, depending on whether the patient has stage 1A or 1B disease and on the location of the tumor. Another study in patients with stage I disease (n = 19,702) found that 82% had surgical resection and their 5-year overall survival was 54%; however, for untreated stage I NSCLC, 5-year overall survival was only 6%. Of patients with stage I disease who refused surgery (although it was recommended), 78% died of lung cancer within 5 years.
病理I期非小细胞肺癌在叶切除术后的5年生存率为45%到65%，取决于患者是IA还是IB期疾病以及肿瘤的位置。另一项I期疾病患者（n = 19702）的研究发现，82%的手术切除，其5年总生存率为54%；然而，对于未治疗的Ⅰ期非小细胞肺癌，5年总生存率仅为6%。在拒绝手术（尽管建议）的I期患者中，78%在5年内死于肺癌。