回顾性分析第8版AJCC/UICC TNM分期系统在预测Ⅰ_a期肺腺癌预后中的价值

Retrospective analysis of value for prognosis prediction in patients with Ⅰ_a stage lung adenocarcinoma based on 8th edition AJCC/UICC TNM staging system

目的:评估第8版AJCC/UICC TNM分期系统对Ⅰa期肺腺癌患者预后的预测价值。方法:回顾性分析郑州人民医院2007年1月至2012年7月行手术切除且病理资料齐全的Ⅰa期肺腺癌患者90例,按照第8版TNM分期系统,预后指标行Kaplan-Meier分析,选择有显著差异指标行Cox多因素分析。结果:Ⅰa期肺腺癌患者总体5年生存率为84. 4%。Kaplan-Meier单因素分析发现年龄、性别、吸烟状态、发病部位、ALK基因状态、EGFR基因状态、手术方式、辅助治疗不影响Ⅰa期肺腺癌患者预后;而肿瘤病理类型、组织分级及第8版TNM分期影响Ⅰa期肺腺癌患者的预后。Cox多因素分析结果显示第8版TNM分期是影响Ⅰa期肺腺癌患者预后的独立危险因素。第7版中Ⅰ_(a1)期和Ⅰ_(a2)期拆分为第8版的Ⅰ_(a1)期、Ⅰ_(a2)期、Ⅰa3期三组,5年生存率分别为96. 9%、88. 9%、67. 7%(P=0. 002)。结论:第8版TNM分期系统能更准确预测Ⅰa期肺腺癌患者的预后。

Objective：To investigate the prognostic value of the 8th edition tumor-node-metastasis （TNM） staging system in patients with Ⅰa stage lung adenocarcinoma.Methods：We retrospectively evaluated 90 cases patients with stage Ⅰa stage lung adenocarcinoma who underwent pneumonectomy and cytopathologic examination treated from January 2007 to June 2012 at Zhengzhou People＇s Hospital.Patients were staged by the 8th edition staging system and followed up.These potential prognostic factors were analyzed with Kaplan-Meier estimation,then multivariate analysis by Cox hazards model was employed to identify prognostic factors.Results：The five-year overall survival rate of patients with Ⅰa stage lung adenocarcinoma was 84.4%.The Kaplan-Meier univariate analysis indicated that the age,gender,smoker status,pathogenic site,ALK status,EGFR status,operation method and adjuvant therapy were not significantly associated with the prognosis.But histology,tumor grade and the 8th edition staging system were significantly associated with the prognosis.The Cox multivariate analysis further showed the 8th TNM staging was the independent prognostic factor.The Ⅰa1 and Ⅰa2 stage of the 7th TNM staging was divided into three groups （Ⅰa1,Ⅰa2,Ⅰa3） of the 8th TNM staging,and five-year survival rates in Ⅰa1,Ⅰa2 and Ⅰa3 stage were 96.9%,88.9% and 67.7% by the 8th TNM staging system （P=0.002）.Conclusion：The 8th TNM staging system can exactly predict prognosis for Ⅰa stage lung adenocarcinoma.