T2 tumors larger than five centimeters in diameter can be upgraded to T3 in non-small cell lung cancer
T2 tumors larger than five centimeters in diameter can be upgraded to T3 in non-small cell lung cancer
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DOI：
10.1067/mtc.2001.116949
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发表时间：
2001-11-01
影响因子：
6
通讯作者：
Motta, G
中科院分区：
文献类型：
--
作者：
Carbone, E;Asamura, H;Motta, G
目的：在TNM分期标准中，肿瘤大小是影响小肿瘤预后的重要因素。T1和T2肿瘤的分界点为3 cm，而大于3 cm的肿瘤则无任何预后价值。相反，N2被认为是最坏的预后因素为intrathoric extended diseases.Method：545例直径大于3 cm的非小细胞肺癌（T2，T3和T4）的预后进行了研究。全肺切除126例，肺叶切除411例，部分切除8例。根据以下因素比较生存率：肿瘤大小（3.1-5 cm、5.1-7 cm、>7 cm）、淋巴结状态、年龄、性别、组织学类型、胸膜受累程度、手术方式、分期和T因子。多因素分析采用考克斯比例风险模型。结果：单因素分析显示，年龄、性别、胸膜受累程度、手术方式、肿瘤大小、淋巴结状态和分期均为影响预后的重要因素。进一步比较相同淋巴结类别中不同肿瘤大小（小于或等于5 cm vs >5 cm）之间的生存率表明，NO（P = 0.00374）和N2+N3（P = 0.0157）中较大肿瘤的预后显著较差，但NI（P = 0.3452）中没有。T2肿瘤（n = 349）根据大小分为T2 a（n = 238）和T2 b（n = 111），并将生存率与T3和T4进行比较。5年生存率分别为51.3%、35.1%、47.8%和25.3%。T2 a和T2 b之间的差异有统计学意义（对数秩P =.0170，Breslow P =.0055）。肿瘤直径大于5 cm表明非小细胞肺癌预后不良，因为T2 b肿瘤患者的生存率与T2 a肿瘤患者的生存率显著不同，生存曲线位于T3和T4肿瘤患者的生存曲线之间。因此，T2 b可能至少升级到T3。
Objective: Among the TNM criteria, tumor size is a well-assessed factor in the prognosis of small tumors. A 3-cm cutoff point separates T1 from T2 tumors, whereas a size larger than 3 cm is not ascribed any prognostic value. Instead, N2 is considered to be the worst prognostic factor for intrathoracic extended disease.Method: The prognosis of 545 patients with non-small cell lung cancer larger than 3 cm in diameter (T2, T3, and T4) was studied. These tumors were completely resected by pneumonectomy (n = 126) or lobectomy (n = 411) or were partially resected (n = 8). Survivals were compared according to the following factors: tumor size (3.1-5 cm, 5.1-7 cm, >7 cm), nodal status, age, sex, histologic type, degree of pleural involvement, operative procedure, stage, and T factor. For the multivariate analysis, the Cox proportional hazard model was used with the same variables.Results: The univariate analysis showed that age, sex, degree of pleural involvement, operative procedure, tumor size, nodal status, and stage were all significant prognostic factors. Further comparison of survival between different tumor sizes (less than or equal to 5 cm vs >5 cm) in the same nodal category demonstrated a significantly poor prognosis for larger tumors in NO (P =.00374) and N2+N3 (P =.0157), but not in NI (P =.3452). T2 tumors (n = 349) were divided, according to size, into T2a (n = 238) and T2b (n = 111), and survival was compared with those in T3 and T4. The 5-year survivals were 51.3%, 35.1%, 47.8%, and 25.3%, respectively. The difference between T2a and T2b was statistically significant (log-rank P =.0170, Breslow P =.0055).Conclusions: A tumor size of more than 5 cm in diameter was indicative of a poor prognosis in non-small cell lung cancer, because patients with T2b tumors had a significantly different survival from that of patients with T2a tumors, and the Survival curve was located between those for patients with T3 and T4 tumors. Consequently, T2b might be upgraded to at least T3.