《2009IASLC肺癌分期分类相关的解剖学、生物学及理念》内容预览

stage classification system provides a common nomen-clature about patients with a particular type of cancer. A common language facilitates communication among different centers, allowing observations from different sources to be combined and thereby enhance our collective knowledge. As knowledge is gained, further details of a staging system can be defined, and thus the system requires periodic revision and refinement. In lung cancer, a major effort led by the Interna-tional Association for the Study of Lung Cancer (IASLC) Staging Committee was undertaken to inform a revision of the Union Internationale Contre le Cancer and American Joint Committee on Cancer staging system,involving an unprecedented extent of data collection and scientific analy-sis.

This has prompted us to reflect on the goals of a staging system, the limitations of our current understanding of the biology of lung cancer, and how underlying concepts can help or hinder our ability to make new observations. Inherent in the development of the nomenclature of a staging system is the ability to define homogeneous patient cohorts. This raises the question of how homogeneity is defined. While many measures can be considered, the one most commonly used is prognosis. Indeed, this is the primary end point used in the analysis and staging recommendations of the IASLC staging committee.Another common ex-pectation of a staging system is to define patient cohorts for which the same treatment approach is appropriate.

However, it must be recognized that prognosis and treatment approaches are not static. There is an incessant quest to define treatments that lead to better outcomes. More-over, prognosis is continually changing due to progress in aspects other than treatment. Advances in imaging affect the prognosis of stage groups through the resultant stage migra-tion.Changing methods of detection (e.g., computed to-mography screening) also affect prognosis by altering the spectrum of disease that is encountered.

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