TNM分期在局限期小细胞肺癌预后评估中的价值

Prognostic value of AJCC TNM Staging 7th edition in limited-stage small cell lung cancer： validation in 437 patients

目的探讨TNM分期对局限期小细胞肺癌（SCLC）预后的影响。方法回顾性分析中国医学科学院肿瘤医院1996-2006年收治的437例局限期SCLC患者的临床资料，按照美国癌症联合委员会（AJCC）第7版TNM分期进行重新分期，其中IA期8例，IB期44例，ⅡA期7例，ⅡB期64例，ⅢA期192例，ⅢB期122例。采用Kaplan-Meier法绘制生存曲线，以Logrank检验对TNM分期行单因素分析。结果全组患者的中位随访时间为64个月，中位生存时间为26．2个月，中位无进展生存时间为13．7个月，1年、2年和5年生存率分别为86．O％、52．7％和29．7％。I、Ⅱ、ⅢA和111B期患者的5年生存率分别为65.8％、47.3％、23．0％和16．3％。TNM分期对SCLC患者的总生存具有明显影响（P〈0．001），其中I期和Ⅱ期患者的5年生存率差异无统计学意义（P=0．069），其余相邻期别间患者的5年生存率差异均有统计学意义（均P〈0．05）。I、Ⅱ、ⅢA和mB期患者的5年无进展生存率分别为53．2％、43．2％、16．8％和10．9％。TNM分期对SCLC患者的无进展生存具有明显影响（P〈0．001），但相邻期别间患者的5年无进展生存率差异均无统计学意义（均P〉0．05）。T分期对SCLC患者的总生存具有明显影响（P〈0．001），但相邻期别间患者的5年生存率差异均无统计学意义（均P〉0．05）。T分期对SCLC患者的无进展生存无明显影响（P=0．194）。N分期对SCLC患者的总生存具有明显影响（P〈0．001），其中N1与N2期患者的5年生存率差异有统计学意义（P=0．001），其他相邻期别间患者的5年生存率差异均无统计学意义（均P〉0．05）。N分期对SCLC患者的无进展生存具有明显影响（P=0．001），其中N2与N3期患者的5年无进展生存率差异有统计学意义（P=0．013），其他相邻期别问患者的5年无进展生存率差异均无统计学意义（均P〉0．05）。I期、Ⅱ期、ⅢA期和ⅢB期患者的脑转移率分别为17．3％、28．6％、33．3％和35．8％，差异无统计学意义（P=O．072）。I期患者中，PI期和cI期患者的脑转移率分别为12．8％和30．8％，差异无统计学意义（P=0．203）。结论局限期SCLC应根据美国国家综合癌症网指南行规范的分期检查，AJCC第7版TNM分期对局限期SCLC患者的预后有较好的预测作用，建议临床工作中广泛采用。

Objective To explore the impact of AJCC TNM Staging 7th edition on survival outcome of limited stage small cell lung cancer （SCLC）. Methods Four hundred and thirty-seven SCLC patients with completed diagnosis and treatment data treated in our department between January 1996 and December 2006 were reclassified according to the AJCC TNM Staging 7th edition. The patients of stages Ⅰ A, Ⅰ B, Ⅱ A, Ⅱ B, ⅢA, ⅢB were 8, 44, 7, 64, 192 eases, respectively. Kaplan-Meier method was used for survival analysis and log-rank test was used to identify the prognostic factors. The survival rate was determined using ehi-sqnare test. Results The median follow-up time was 64 months. The median survival time was 26.2 months and median progression free survival time was 13.7 months. The 1-, 2- and 5-year overall survival rates were 86.0%, 52.7%, and 29.7%, respectively. The log-rank test showed that TNM stage is a statistically significant prognostic factor for OS in LS-SCLC （P 〈 0.001 ）. TNM staging system generally allowed a good separation in pairwise comparison for OS between successive stages except there was no significant difference between stages I and 171 （P = 0.061 ）. The 5-year progression free survival rates of patients of stage I , 11 , IliA and IIIB were 53.2%, 43.2%, 16.8%, and 10.9%, respectively. TNM stage also was a statistically significant prognostic factor for PFS in LS-SCLC （P〈 0.001 ）, but there was no significant difference between successive stages （P〉 0.05 for all）. The T staging confirmed significant influence on OS （P〈0.001） with no significant difference between successive stages （P〉0.05 for all）, while T stage was not a significant prognostic factor for PFS in the LS-SCLC patients （P= 0.194）.N stage also had a significant influence on OS （P〈0.001）, but with no significant differences between successive stages except N1 and N2 （P= 0.001 ）. N staging also showed significant influence on PFS （P= 0.001 ）, but with no significant difference between successive stages （P〉0.05） except that between the 5-year survival rates of N2 and N3 cases （P=0.013）. The cumulative brain metastasis rates of stages Ⅰ , Ⅱ, Ⅲ, and stage liB were 17.3%, 28.6%, 33.3%, and 35.8%, respectively（P= 0.072）, and were 12.8% and 30.8% for pathological stage I and clinical stage I （ P = 0. 203 ）. Conclusion AJCC TNM Staging 7th edition criteria for LS-SCLC patients have a high prognostic impact and therefore are preferable in clinical practice and future therapeutic trials.