《肿瘤瞭望》：请您谈一谈IASLC 第八版肺癌TNM分期对临床实践的影响？

　　Peter Goldstraw教授： IASLC 肺癌TNM分期即将发生变化。各个专业领域的人士（包括放射肿瘤学家、病理学家、外科或内科医生）都在使用TNM分类，TNM分期的变化将在世界范围内产生影响。首先，TNM分类是用T、N、M等参数判断肿瘤、区域淋巴结扩散和远处转移的预测系统，记录患者的肿瘤侵犯程度。TNM分期不能判断患者的预后，但它可能是最强的预后因素，TNM分期对患者的治疗决策有极大帮助。TNM系统自1960年代初以来一直在使用，并定期修改，但是这些修改通常是基于很少的数据，在某些情况下，没有任何数据。因此，国际肺癌研究协会（IASLC）在1998做出重要的战略决策，它将在全球范围内收集数据并分析数据（这项工作耗资巨大，每年花费百万美元），共从世界各地收集了约100000肺癌病例（包括小细胞肺癌和非小细胞癌的病例），患者采用了各种方式的治疗（手术、化疗、放疗、最佳支持治疗、单项治疗和多模态治疗）。

　　第八版TNM分期今年将发布，并将于2017年1月1日实施，将影响全球患者的日常管理。这些数据由世界各地的20多个数据中心捐赠，所有的数据被提交给西雅图癌症研究及生物统计学(CRAB)数据中心。数据分析刚刚结束，我们提出了修改建议，涉及T、N、M的改变。在ELCC 2016会议上，R. Rami-Porta教授介绍了T分期的变化，H. Asamura，介绍了N分期，W. Eberhardt介绍了M分期，我介绍了TNM分期对于分期和治疗的意义。为了帮助临床医生了解TNM分期的变化，我们印刷了一系列教育产品，将在今年WCLC会议上发布。

　　《肿瘤瞭望》：您对哪些会议报告最感兴趣？

　　Peter Goldstraw教授：在一个多学科会议上，外科医生必须解释为什么他认为外科手术在任何特殊情况下都是合适的。而放射肿瘤学家也要论证放疗更好。在一个专场，外科医生和外科医生之间讨论手术更好（或放疗专家和放疗专家之间论证放疗更好），大家都同意这个观点，这种会议形式并不能反映临床现实。为了达到最佳效果，必须举行各个学科专家之间的公开对话，每个人向会议协调者提出他们能为患者做出的贡献，如果他们无能为力也必须坦白。这可能意味着患者需要2种或更多的治疗方式，各领域的医疗专家作为一个团队，使患者的治疗达到最佳结果。

　　在ELCC 2016会议上，几个领域的研究值得注意。其中之一是亚肺叶切除术的应用。肺叶切除加系统性纵隔淋巴结清扫/活检仍为肺癌标准手术治疗。肺癌筛查的普及使我们发现了更多的早期癌症，我们也发现了不同类型的癌症，因此我们需要展开个性化的手术治疗，个性化手术治疗意味着切除最少的组织并不损害治疗效果。我们需要研究的是“我们应该如何识别这些能实施较小切除术的患者群体（比如楔形切除或肺段切除术）？如果实施亚肺叶切除术，应清扫多少淋巴结？手术效果如何？ 这是ELCC 2016会议的重点之一。

访谈原文

　　Oncology Frontier: Would you please talk about the impact of “IASLC new staging system in NSCLC” on clinical practice?

　　肿瘤瞭望：请你谈一谈IASLC 第八版肺癌TNM分期对临床实践的影响？

　　Dr Goldstraw: Regarding the TNM classification and revision， we are approaching an important time in the lives of all oncologists when the TNM classification changes. The TNM classification is something that oncologists in every sphere of expertise， whether it is radiology， pathology， surgery or medical oncology， are using on every patient they see every day. When that changes， it is of vital importance to every specialist in every geographical region of the world. The first thing to emphasize is that the TNM classification is a prognostic system based on a shorthand using the T， N and M parameters to look at the primary tumor， the regional lymph node spread and the distant metastases and document the anatomical extent of a cancer. That is all it does.It doesn’t describe the whole of the patient’s prognosis， but it is probably the strongest prognostic factor and is a great help in deciding which treatment to use in any one patient.

　　The TNM system has been in use since the early 1960s and we have had periodic revisions which have usually been based on very little data or， in some cases， no data at all. So the International Association for the Study of Lung Cancer made a strategic decision back in 1998 that it would fund the collection of data globally and analyze that data. That is a very expensive business and costs a couple of million dollars every year. That information was to be given to the lung cancer community as a gift. The second revision has now been funded. The eighth edition will be coming out later this year and will be implemented on January 1st， 2017. To facilitate that revision， the IASLC collected an almost entirely new database of almost 100000 lung cancer cases from around the world， small cell and non-small cell cancer， treated using all modalities of care (surgery， chemotherapy， radiotherapy， best supportive care， single and multiple modality strategies). The data were donated by 20+ data centers around the world and we are very grateful to them for doing that. All the data was submitted to a data center in Seattle， Cancer Research and Biostatistics (CRAB). The analysis of that data has just been finished and we have come up with proposals. There are proposals for changes to the T categories， N categories and M categories and putting those proposals together has indicated the changes that are necessary in the resultant stage categories. I have presented that analysis here today. The present Chair of the Staging and Prognostic Factors Committee spoke on the T categories. The Chair-Elect of the project (to start in January) spoke on the N categories. My colleague， Dr Eberhardt， spoke on the M categories and I pulled those together looking at the resultant TNM stage groupings. Because this will be introduced globally on January 1st， 2017， it will affect the day-to-day management of patients around the globe. Clinicians need to know what those changes are because they will need to discuss them with their multidisciplinary teams and start preparing for the 1st of January. To help them do that， the IASLC is producing a raft of educational products. There will be a staging manual in thoracic oncology. We produced the first one in 2009， which covered lung cancer and mesothelioma. The next one， which will be published at the world conference in Vienna in December 2016， will include our 8th edition for lung cancer， mesothelioma and thymic malignancies， and also recommendations for the classification of esophageal cancer， both adenocarcinoma and squamous carcinoma. At the moment， we are encouraging oncologists to come to the world conference so they can hear those final recommendations and obtain the educational products to discuss with their multidisciplinary team back home in good time so as to be prepared for the new system coming into force on January 1st， 2017.

　　Goldstraw教授：IASLC 肺癌TNM分期即将发生变化。各个专业领域的人士（包括放射肿瘤学家、病理学家、外科或内科医生）都在使用TNM分类，TNM分期的变化将在世界范围内产生影响。首先，TNM分类是用T、N、M等参数判断肿瘤、区域淋巴结扩散和远处转移的预测系统，记录患者的肿瘤侵犯程度。TNM分期不能判断患者的预后，但它可能是最强的预后因素，TNM分期对患者的治疗决策有极大帮助。

　　TNM系统自1960年代初以来一直在使用，并定期修改，但是这些修改通常是基于很少的数据，在某些情况下，没有任何数据。因此，国际肺癌研究协会（IASLC）在1998做出重要的战略决策，它将在全球范围内收集数据并分析数据（这项工作耗资巨大，每年花费百万美元），从世界各地收集约100000肺癌病例（包括小细胞肺癌和非小细胞癌的病例），患者采用了各种方式的治疗（手术、化疗、放疗、最佳支持治疗、单项治疗和多模态治疗）。

　　第八版TNM分期今年将发布，并将于2017年1月1日实施，将影响全球患者的日常管理。这些数据由世界各地的20多个数据中心捐赠，所有的数据被提交给西雅图癌症研究及生物统计学(CRAB)数据中心。数据分析刚刚结束，我们提出了修改建议，涉及T、N、M的改变。在ELCC 2016会议上，R. Rami-Porta教授介绍了T分期的变化，H. Asamura，介绍了N分期，W. Eberhardt介绍了M分期，我介绍了TNM分期对于分期和治疗的意义。为了帮助临床医生了解TNM分期的变化，我们印刷了一系列教育产品，将在今年WCLC会议上发布，涵盖肺癌、间皮瘤、胸腺恶性肿瘤，以及对食管癌（腺癌和鳞状细胞癌）的分类建议。

　　Oncology Frontier:  Which report of the meeting are you most interested in？

　　肿瘤瞭望：您对哪些会议报告最感兴趣？

　　Dr Goldstraw: The European Lung Cancer Conference is a joint venture. The lead is taken by the European Society of Medical Oncology (ESMO)， but also receives a great deal of support from the IASLC and another society I am particularly keen on， the European Society of Thoracic Surgeons. So we have here representatives from every modality of care and it is nice to have that multidisciplinary discussion on the management of problematic issues in lung cancer. Obviously， as a thoracic surgeon， I am interested in the thoracic surgery topics， but realistically， at a multidisciplinary meeting， as a surgeon， I have to explain why I think surgery is appropriate in any particular case. There will be radio-oncologists at the meeting who will suggest that maybe they can help more.

　　There has to be that dialogue. Because we have that dialogue in our clinics， we need to have that dialogue in our scientific sessions. It is irrelevant today having a session where only surgeons discuss cases because we will all agree and that does not reflect real life situations. Similarly， it is no good having a session where only radiation oncologists are talking to each other where they will be saying that radiation oncologists cure everybody. That is not the case. To achieve the best results for patients， we have to have an open dialogue in which each person brings their expertise to the table and presents the coordinator of the discussion with what they have to offer. Sometimes， they have to be frank and say they have nothing to offer a certain patient， but it is usually a discussion over what can be done as a team culminating in the best result for the patient. That may mean two or more modalities of care are required for the best outcomes and so that is what we should recommend.

　　Goldstraw教授：欧洲肺癌大会由ESMO主办，也得到了IASLC其他团体的支持。会议内容涉及多个学科，作为一名胸外科医生，我对胸外科的主题感兴趣。在一个多学科会议上，作为一名外科医生，我必须解释为什么我认为外科手术在任何特殊情况下都是合适的。而放射肿瘤学家也要论证放疗更好。在一个专场，外科医生和外科医生之间讨论手术更好（或放疗专家和放疗专家之间论证放疗更好），大家都同意这个观点，这种会议形式并不能反映临床现实。为了达到最佳效果，必须举行各个学科专家之间的公开对话，每个人向会议协调者提出他们能为患者做出的贡献，如果他们无能为力也必须坦白。这可能意味着患者需要2种或更多的治疗方式，各领域的医疗专家作为一个团队，使患者的治疗达到最佳结果。

　　Oncology Frontier: According to ELCC 2016， Is there any progress that may change practice in Lung Cancer?

　　肿瘤瞭望：ELCC 2016会议有没有展示能改变肺癌临床实践的进展？

　　Dr Goldstraw: I am only competent to talk about the surgical aspects， but I think there are a few areas that are worth noting. One is the developing role of sublobar resections. We have traditionally felt that if you go for a curative treatment by surgical means， the least resection we should do is a lobectomy and that should be coupled with a thorough examination of the lymph nodes preoperatively and perioperatively. At the time of surgery， the surgeon will remove loads of lymph nodes to give the most comprehensive analysis of the true stage and give the patient the best chance of cure. Lung cancer is evolving and it is evolving in several ways. Certainly in the West， we are seeing it becoming less of a smoking condition and more of a non-smokers problem and less male predominated with a greater balance between male and female incidence. Because of the rising popularity of CT screening， we are seeing smaller and earlier stage cancers in a larger proportion of patients. Because we are seeing different cancers (and we know in Asia， there is also a population of people who have specific molecular changes as targets for different drugs)， we have to personalize the surgery just as we have personalized the medical treatment in the last few years. Personalizing surgery means making sure that we offer the patient the least resection without compromising the prospect of cure. There is evidence accruing now that there are subsets of patients that we can identify preoperatively and confirm at time of surgery by thoracotomy or video-assisted thoracoscopy， so that they can have a lesser resection than a lobectomy without compromising on their cure. The discussions going on are: how do we identify those groups; do we do wedge resections or segmentectomy; and if we do these lesser resections， how much of the lymph node dissection we would normally do should we continue to do; and how good are the results? That is a major thrust we have had at this conference.

　　Goldstraw博士：我只能谈一谈手术方面的研究，有几个领域的研究值得注意。其中之一是亚肺叶切除术的应用。肺叶切除加系统性纵隔淋巴结清扫/活检仍为肺癌标准手术治疗。而在西方国家，肺癌患者中吸烟者的比例逐渐减少，有更多的非吸烟者、男性和女性的发病率之间更加平衡，肺癌筛查的普及使我们发现了更多的早期癌症。我们也发现了不同类型的癌症，因此我们需要展开个性化的手术治疗，个性化手术治疗意味着切除最少的组织并不损害治疗效果。我们需要研究的是“我们应该如何识别这些能实施较小切除术的患者群体（比如楔形切除或肺段切除术），如果实施亚肺叶切除术，应清扫多少淋巴结，手术效果如何，这是ELCC 2016会议的重点之一。