Evaluation of the new (1987) TNM classification for thoracic esophageal tumors

A total of 351 patients with thoracic esophageal carcinoma were prospectively classified according to the new (1987) TNM classification. Sixty-two patients received chemotherapy and/or radiotherapy without surgery. Esophagectomy was performed on 291 patients, among whom 139 underwent cervical, mediastinal and abdominal lymph adenectomy (3-field dissection). The number of stage IIB patients was unnaturally small, and the 3-year survival rates of stages IIA and IIB were similar. The survival curves for patients of T, N and M categories distributed well except for those of stages IIA and IIB. Numbers of patients in N and pN categories and those in M and pM categories showed poor coincidence. The 5-year survival rate for MI patients (10.5%) was too good, which suggested the mingling of patients with rather better prognosis. When MI (LYM) patients were excluded from MI, the 3-year survival rate fell to 0.3%. The 5-year survival rate for pMI (LYM) patients who underwent 3-field dissection was 38.2%. Survival rates and numbers of positive nodes showed negative correlation in patients who underwent 3-field dissection. According to these results, we propose the following revision in the next TNM classification: (1) to group stage IIA and stage IIB together to form Stage II; (2) to include cervical and coeliac lymph nodes among the regional lymph nodes, or to designate metastasis in non-regional lymph nodes separately from metastasis in viscera; and (3) to divide N1 into N1 and N2 according to the number of positive lymph nodes.