Validation of the TNM classification (4th edn) for lung cancer: first results of a prospective study of 1086 patients with surgical treatment

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Abstract
For the purpose of testing the validity of the new TNM classification(fourth edition) for lung cancer, data from 1086 patients with surgicaltreatment were analysed prospectively. Several items were examined: (1) theagreement between clinical (TNM) and pathologically confirmedclassification (pTNM); (2) the value of the various diagnostic tests inestimating the pathologically confirmed classification; (3) the influenceof the TNM definitions on separating distinct prognostic groups. Withregard to the primary tumour (T), clinical and pathological classificationwere identical in 64% of the cases. With regard to lymph node involvement(N), the agreement was 48%, for distant metastasis 90% and for the staging55%. As for the primary tumour (T), the accuracy of radiography (59%) wasnearly identical with that of computed tomography (58%). Both thesediagnostic techniques were less precise in determining the extent of lymphnode involvement (computed tomography 50% correct assessments, radiography43%). The statistically significant differences in the prognoses for thevarious pT, pN and pM categories as well as for the pathological stages andthe categories of the new R classification could be confirmed. The new 1987TNM definitions for lung cancer make possible international conformity; theclassification is also practically useful and the prognostic relevanceimproved. The new classifications thus provide a more reliable basis forestablishing guidelines for individual oncological therapy strategies andfor the exchange of information between different centres on the progressmade in diagnosis and therapy of lung cancer.

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