国际肺癌研究会2007年版肺癌分期方案的应用

Application of the 2007 lung cancer staging system by International Association for the Study of Lung Cancer

目的:比较国际抗癌联盟(International Union Against Cancer,UICC)和美国癌症联合会(American Joint Committeon Cancer,AJCC)于1997年公布的第6版非小细胞肺癌TNM分期方案(以下简称第6版方案),与国际肺癌研究会(International Association for the Study of Lung Cancer,IASLC)2007年提出的非小细胞肺癌TNM分期的修改方案(以下简称新方案)对中国非小细胞肺癌患者预后预测的不同点。方法:根据2003年9月至2005年10月北京大学临床肿瘤学院胸外科手术治疗的136例非小细胞肺癌患者的存档资料,分别按照第6版方案和新方案进行病理分期,主要观察目标为不同分期下的两年无复发转移生存率和无复发转移生存期,用Kaplan-Meier和Log-rank法进行统计学检验。结果:(1)第6版方案中Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者例数分别为56、23、53和4例;在新方案中Ⅰ、Ⅱ、Ⅲ和Ⅳ期患者例数分别为50、31、54和1例,其中第6版方案中有6例Ⅰ期在新方案中变成Ⅱ期,1例Ⅱ期变成Ⅲ期,3例Ⅲ期变成Ⅱ期,1例Ⅲ期变成Ⅳ期,4例Ⅳ期变成Ⅲ期。(2)第6版方案中Ⅰa、Ⅰb、Ⅱa、Ⅱb、Ⅲa、Ⅲb和Ⅳ期患者的两年无复发转移生存率分别为95.5%、82.4%、100.0%、63.6%、52.1%、80.0%和50.0%;新方案中Ⅰa、Ⅰb、Ⅱa、Ⅱb、Ⅲa、Ⅲb和Ⅳ期患者的两年无复发转移生存率分别为95.5%、89.3%、68.4%、63.6%、52.8%、50.0%和0.0%。(3)按照第6版方案,经Log-rank法分析后显示,Ⅰ期和Ⅱ期患者的2年无复发转移生存期差异无统计学意义(P=0.232),Ⅱ期和Ⅲ期患者的无复发转移生存期差异有统计学意义(P=0.023);按照新方案,Ⅰ期和Ⅱ期,以及Ⅱ和Ⅲ期患者之间的无复发转移生存期差异均有统计学意义(P值分别为0.023和0.014)。(4)新方案中新增的2和5cm这两个节点上下的患者的无复发转移生存期差异有统计学意义(P值分别为0.025和0.023)。结论:IASLC2007版非小细胞肺癌TNM分期方案较UICC和AJCC的第6版非小细胞肺癌TNM分期方案显示了更好的分期特异性,且新方案一样适用于中国非小细胞肺癌患者。

Objective： To compare the prognoses of non-small cell lung cancer patients based respectively on the 6th-Edition Staging System for NSCLC （the 6th-Edition Staging System） and the new staging system by the International Association for the Study of Lung Cancer （IASLC） （new staging system）. Methods： Data were collected from 136 operated NSCLC patients from Sep. 2003 through Oct. 2007. Those data were staged based respectively on the 6 th-Edition Staging System and the new staging system. The 2-year no-recurrence survival rate was calculated, and life span was analyzed using the Kaplan-Meier method of SPSS 13.0 software. Results： （1） In this series, using the 6th-Edition Staging System, there were 56, 23, 53 and 4 patients in stage I , stage Ⅱ , stage Ⅲ and stage Ⅳ respectively ; using the new staging system, there were 50, 31, 54 and I patients in stage I , stage Ⅱ , stage Ⅲ and stage Ⅳ respectively. There were 6 patients in stage I according to the 6th-Edition Staging System who had become 6 patients in stage Ⅱ according to the new staging system, 1 patient in stage Ⅱ 1 in stage Ⅲ, 3 patients in stage Ⅲ 3 in stage Ⅱ, 1 patient in stage Ⅲ 1 in stage IV, and 4 patients in stage Ⅳ 4 in stage Ⅲ. （2） According to the 6th-Edition Staging System, the 2-year no-recurrence survival rates for I a, I b, Ⅱa, Ⅲb,Ⅲa, mband IV were95.0%, 83.3%, 100.0% 63.6%, 52.1%, 80.0% and 50.0% respectively, and according to the new staging system, the 2-year cumulative survival rates for I a, I b, Ⅱa, Ⅱb, Ⅲa, mband Ⅳ were 95.5%, 89.3%, 68.4%, 63.6%, 52.8%, 50.0% and 0.0% respectively. After Chi square analysis, there was no distinguished difference between the 2 sta-ging systems for the 2-year cumulative survival rate. （3） According to the 6th-Edition Staging System, the difference between the no-recurrence rate of stage I and stage II was not statistically significant （P = 0. 232 ）, and the difference between the no-recurrence （P = 0. 023 ） ; according to the new staging system, rates of stage II and m was statistically significant the difference between the no-recurrence rates of stage I and stage II as well as between those of stage Ⅱ and stage Ⅲ were both statistically significant （P =0. 023 and 0. 014 respectively ）. （4） The differences between the no-recurrence rates of the patients on the two sides, above and below the tumor maximum diameter cutpoint 2 cm, as well as the cutpoint 5 cm were statistically significant （ P = 0. 025 ; P = 0. 023 ）. Conclusion ： The new staging system by NSCLC has better staging specificity than the 6th-Edition Staging System and could be used for Chinese patients.