The New TNM Classification and Stage Grouping of Intrathoracic Oesophageal Carcinoma

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Abstract
The changes resulting from the 4th edition of the TNM classification of carcinoma of the oesophagus are presented in detail. Comparative assessment of the efficacy of clinic - diagnostic procedures has been made possible through the adoption of identical criteria for T and pT. The 4th edition is compared to the former 3rd edition using data from patients who underwent resection of squamous cell carcinoma of the intrathoracic oesophagus at the Department of Surgery of the University of Erlangen between 1969–86. The new pT4 category permits the identification of patients in whom a curative tumour resection is no longer possible. Because of the new definition of regional lymph nodes, a portion of the patients classified as M1 to date are reclassified as M0. The difference in prognosis between M0 and M1 patients is thereby more pronounced and patients with definitely poor prognosis are better identified. The new stage grouping carries a better predictive value with respect to the incidence of possible R0 resections and especially permits a considerably improved prognostic assessment. Five-year survival rates drop from 67% in stage I to 0% in stage IV. For the first time, the advantages of the new edition of the TNM classification and stage grouping are demonstrated on a study group from a western country.

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