UICC第8版肺癌淋巴结分期方案及淋巴结分期建议方案的验证

Validation of the lymph node stage of UICC 8th edition TNM classification and the proposed revision lymph node stage for lung cancer

目的验证UICC第8版淋巴结(N)分期和N分期的建议修改方案在中国肺癌患者中的应用价值。方法分别应用UICC第8版N分期方案和N分期的建议修改方案对3281例非小细胞肺癌术后患者的数据进行分期,采用KaplanMeier法对每个阶段的患者进行生存分析,COX回归法评估各亚组间的差异。结果按照UICC第8版TNM分期中N分期定义,患者的5年生存率分别为:N0期75.8%,N1期60.5%,N2期33.3%,N3期4.2%,每两相邻的N分期间的差异均有统计学意义;根据建议修改方案定义进一步分析显示,各亚组患者的5年生存率分别为:N0期75.8%,N1a期64.7%,N1b期55.7%,N2a1期47.2%,N2a2期38.6%,N2b期16.4%,N3期4.2%,除N1b及N2a1这两个亚组间以外,相邻的两个N分期亚组间的差异均有统计学意义。结论UICC第8版N分期和N分期的建议修改方案均可很好地指导中国肺癌患者的淋巴结分期,而N分期的建议修改方案能够更准确地反映淋巴结的肿瘤负荷。

Objective To verif y the application value of the lymph node(N)stage of the UICC 8th edition TNM classification for lung cancer and the proposed revision N stage in Chinese lung cancer patients.Methods The medical data of 3281 patients,diagnosed as stageⅠtoⅣNSCLC and undergone tumor resection and systematic N dissection or systematic N sampling at the Department of Thoracic SurgeryⅡ,Cancer Hospital of Peking University,were staged according to the N stage of UICC 8th edition TNM classification and the proposed revision N stage respectively.Kaplan-Meier method was used to analyze the survival of patients at each stage.Cox regression method was used to assess the differences between subgroups.Results According to the definition of N stage of the 8th edition TNM classification,the 5-year survival rates were:75.8%for N0,60.5%for N1,33.3%for N2,and 4.2%for N3,showing significant differences between each two adjacent N stages.According to the purposed revision N stage,the 5-year survival rates of each subgroup were 75.8%for N0,64.7%for N1a,55.7%for N1b,and 47.2%for N2a1,38.6%for N2a2,16.4%for N2b,and 4.2%for N3,showing significant difference between each two adjacent N subgroups except that between N1b and N2a1.Conclusions Both the N stage of the UICC 8th edition TNM classification and the purposed revision N stage can guide the lymph node staging of lung cancer patients in China.The purposed revision N stage can reflect the tumor burden of lymph nodes more accurately.