肺癌临床TNM分期与手术病理TNM分期的比较分析

Comparison between clinical and surgical-pathological TNM staging in patients with lung cancer

背景与目的 肺癌临床TNM分期准确与否直接关系到患者的处理决策是否恰当。本研究旨 在探讨肺癌临床与手术病理TNM分期的一致性并分析其原因。方法 随机抽取我院2000年以来接受手术 治疗的肺癌患者150例,根据1997年新修订的国际肺癌分期标准分别进行临床和手术病理TNM分期,对两 种分期结果采用Kappa统计量进行一致性分析,同时比较T分期各亚组临床与手术病理分期的符合率。结 果 临床与手术病理T分期的一致性较为满意(Kappa值=0.729),但将病例分层分析后发现,临床T3、临床 T4组与手术病理结果的符合率明显低于临床T1和临床T2组(P<0.01)。临床与手术病理N分期的一致性 不够理想(Kappa值=0.108),两种TNM分期的一致程度也随之降低(Kappa值=0.287)。结论 目前基于 CT的肺癌临床T分期能较为真实地反映肿瘤的部位、大小,但是当原发灶靠近胸壁或者纵隔时,其边界不易 确定,部分临床T4病例仍可获得完全性切除。临床与手术病理N分期的一致程度不够理想,寻找更可靠的 术前诊断淋巴结转移的技术是提高肺癌临床TNM分期准确性的关键。

Background and objective The accuracy of clinical TNM staging correlates with appropriate treatment in patients with lung cancer. The aim of this study is to evaluate the agreement between clinical and surgical-pathological staging in patients with lung cancer and analyze its cause in detail. Methods One hundred and fifty patients with lung cancer treated surgically from 2000 were enrolled randomly. Clinical and surgical-pathological staging of them were made respectively according to the International System for Staging Lung Cancer newly revised by UICC. Then concordance was determined between the two staging results with Kappa value, and difference in coincident rate was analyzed among subgroups of T staging. Results For T staging, the agreement was excellent (Kappa value=0.729), however, the coincident rate of T3 or T4 was significantly lower than that in T1 or T2 group (P<0.01). The agreement of N staging was poor (Kappa value=0.108), followed by a disappointed conformity of TNM staging (Kappa value=0.287). Conclusion Clinical T staging based on CT can indicate the location and size of primary tumor precisely. But the borderline may be difficult to estimate when tumor site is near chest wall or mediastinum, so some patients with clinical T4 still have chances to receive complete resection. The conformity of N staging is rather poor. The key point to improve the accuracy of clinical TNM staging should be to seek more reliable techniques for evaluating N status.