Prognostic assessment of 2,361 patients who underwent pulmonary resection for non-small cell lung cancer, stage I, II, and IIIA
Prognostic assessment of 2,361 patients who underwent pulmonary resection for non-small cell lung cancer, stage I, II, and IIIA
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DOI：
10.1378/chest.117.2.374
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发表时间：
2000-02-01
期刊：
影响因子：
9.6
通讯作者：
van den Bosch, JMM
中科院分区：
文献类型：
--
作者：
van Rens, MTM;de la Rivière, AB;van den Bosch, JMM
研究目的：肺癌的分期和分类对于患者管理和临床研究都很重要。分析原发性非小细胞肺癌（NSCLC）患者切除术后的生存结果，以验证近期对分期系统的改进。设计：回顾性研究;时间段为1970年至1992年;随访时间大于或等于5年。患者：共2，361例既往未经治疗的I、II或IIIA期原发性NSCLC患者接受切除术。测量：采用Kaplan-Meier生存分析方法从手术日期开始估计生存率，排除手术后30天内的死亡。结果：术后死亡率为3.9%，术后死亡率为3.9%。对于生存分析，纳入了2，263例患者。总的5年生存率为937/2，263（41.4%）。IA期的5年生存率为255/404（63%）; IB期为367/797（46%）; IIA期为43/83（52%）; IIB期为210/642（33%）; IIIA期为63/337（19%）。IB期和IIA期之间的生存率无显著差异。术后4年内，手术年龄对生存率无影响，5年后，> 65岁患者生存率明显降低。结论：TNM分期系统能准确反映原发性NSCLC的预后，但某些分期定义值得商榷。尽管该分期系统是建立在临床数据基础上的，但本分析（包括术后数据）证实了T2 N 0 M0和T1 N1 M0患者的生存率相似。这些结果也强调了两个独立的亚阶段的使用，特别是因为这些患者在可能的情况下提供手术。
Study objectives: Staging and classification in lung cancer are important for both patient management and clinical research. Results of survival after resection in patients with primary non-small cell lung cancer (NSCLC) are analyzed in order to validate recent refinements of the staging system.Design: Retrospective study; period from 1970 to 1992; follow-up greater than or equal to 5 years.Patients: A total of 2,361 previously untreated patients who underwent resection for stage I, II, or IIIA primary NSCLC.Measurements: Survival was estimated from the date of operation using the Kaplan-Meier survival analysis method, Deaths within 30 days of operation were excluded. Survival comparisons of different surgical-pathologic TNM classification (based on pathologic examination of resected specimens) as well as further discriminative factors were analyzed by log-rank test.Results: Postoperative death occurred in 3.9% of patients. For survival analyses, 2,263 patients were included. The overall 5-year survival was 937/2,263 (41.4%). Five-year survival in stage IA was 255/404 (63%); in stage IB, 367/797 (46%); in stage IIA, 43/83 (52%); in stage IIB, 210/642 (33%); and in stage IIIA, 63/337 (19%). No significant difference in survival was demonstrated between stages IB and IIA. Until 4 years after surgery, age at operation did not influence survival; after 5 years, patients > 65 years old had a significantly lower survival,Conclusion: The TNM staging system accurately reflects the prognosis in primary NSCLC, but some stage definitions can be discussed. Despite the fact that the staging system is built on clinical data, the present analysis, which includes postsurgical data, confirms the similar survival of patients with T2N0M0 and T1N1M0. These results also stress the use of two separate substages, especially because these patients are offered surgery when possible.