第8版UICC TNM分期对临床0和Ⅰ期肺腺癌患者预后判断优越性检验

Judgement of the 8th TNM classification of UICC on the prognosis of surgically managed patients with clinical stage 0-Ⅰ lung adenocarcinoma

目的最新的肺癌UICC TNM分期标准(第8版)发布于2017-01,与第7版相比,大部分变化发生在临床Ⅰ期。本研究旨在证实第8版TNM分期对手术治疗的临床0~Ⅰ期肺腺癌患者预后判断的优越性。方法回顾性分析中国医科大学附属第一医院2002-01-01-2010-12-31手术治疗的临床Ⅰ期(第7版)肺腺癌患者292例临床资料,根据第8版重新进行分期。使用生存分析评估两版分期对患者预后的影响。结果单因素生存分析显示,临床肿瘤大小(临床T因素,第8版)在影响患者的总体生存(P=0.001)、无复发生存(P<0.001)及肺癌特异性生存(P=0.004)方面差异有统计学意义。而临床T因素(第7版)在影响患者的总体生存(P=0.953)、无复发生存(P=0.310)及肺癌特异性生存(P=0.926)方面差异无统计学意义。多因素生存分析显示,临床T因素(第8版)是影响患者总体生存(P=0.025)和无复发生存(P=0.020)的独立预后因素。结论在预测临床0~Ⅰ期肺腺癌的术后预后方面,第8版TNM分期较第7版更为精确。

OBJECTIVE The latest 8th TNM classification of UICC for lung cancer was published in January 2017. Compared with the seventh edition,most of the changes occurred in clinical stage Ⅰ . This study aimed to verify the superiority of the judgement of the 8th TNM classification on the prognosis of surgically managed patients with clinical stage 0-Ⅰ lung adenocarcinoma. METHODS A total of 292 cases of clinical stage Ⅰ (7th classification) lung adenocarcinoma patients who underwent surgery in First Affiliated Hospital of China Medical University from January 1st,2002 to December 31st,2010 were analyzed retrospectively, and reclassified by the 8th classification. Survival analysis was used to evaluate the impact of the two classifications on the prognosis of the patients. RESULTS The clinical tumor size (The clinical T-factor,8th edition) was statistically significant for the overall survival(P = 0. 001), the recurrence-free survival(P< 0. 001) and the lung cancer-specific survival(P=0. 004) according to the univariate survival analysis. In contrast,the clinical T-factor (7th) was not (P = 0. 953,P=0. 310,and P=0. 926 respectively). The clinical T-factor (8th) was the independent prognostic factor for the patients in overall survival(P=0. 025) and recurrence-free survival(P = 0. 020) according to the multivariate survival analysis. CONCLUSION The 8th TNM classification is more accurate in predicting postoperative prognosis than the 7th one in clinical stage 0-Ⅰ lung adenocarcinoma.