新版TNM分期系统在肾透明细胞癌患者中的应用局限性和改进设想

Limitations and improvements of the revised tumor node metastasis(TNM)staging system of clear cell renal cell carcinoma

目的本文对在中国肾癌患者中运用2010版TNM分期系统进行预后评估,研究该系统的应用局限性,并提出改良设想。方法总共纳入了自2003年至2011年间共计1 216例患有肾透明细胞癌行根治性或部分性肾切除的患者,所有病例均经过2010版TNM分期系统划分入组并计算生存数据。单因素和多因素Cox回归模型用来评估术后肿瘤特异性生存期和无进展生存期。连续性变量如年龄、肿瘤直径用x±s的形式表示。生存数据通过Kaplan-Meier分析得到,组间差异通过Log-rank检验得出。结果我们发现在中国肾癌人群中T2a与T2b分期对于生存预后评估无统计学差异,且应用新版分期后,92%的T3期患者被划为T3a期。我们在T3a患者中采用肿瘤直径10cm为界、侵犯部位不同等方法进一步区分,发现对于T3a期患者的预后可以进一步进行区分。结论我们认为有必要将T3a期按照肿瘤直径或者侵犯部位来分组更加精确地预测预后,而对于T2期患者进一步分期的价值有待更大样本量的随访数据来确定。

ABSTRACT：Objective To evaluate whether the revised 2010 Tumor Node Metastasis （TNM） staging system could lead to a more accurate prediction of the prognosis of renal cell carcinoma （RCC） .Methods A total of 1 ,216 patients who had un‐dergone radical or partial nephrectomy for RCC during 2003 and 2011 were enrolled .All patients had pathologically confirmed clear cell RCC （ccRCC） .All cases were staged by 2010 TNM staging systems after pathological review ,and survival data were collected .Univariate and multivariate Cox regression models were used to evaluate cancer‐specific survival （CSS） and progres‐sion‐free survival （PFS） after surgery .Continuous variables ,such as age and tumor diameter ,were calculated as mean values and standard deviations （s .d .） or as median values .Survival rates were calculated with Kaplan‐Meier method ,and differences were assessed with log‐rank tests .Results When using the revised 2010 staging system ,we found that more than 92% of pa‐tients with T3 tumors were staged in the T3a subgroup ,and their survival rates were not significantly different from those of patients with T2b tumors .In addition ,T2 subclassification failed to independently predict the survival rate for RCC patients . When we used the size of tumor and site of invasion to subgroup the T3a patients ,the prognosis of RCC patients could be evalu‐ated more accurately .Conclusion There will be better prognosis if T3a patients are subgrouped by the size of tumor and site of invasion .We need more clinical data to identify the difference in survival rates between the T2a and T2b subgroups .