The IASLC lung cancer staging project: Proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer
The IASLC lung cancer staging project: Proposals for revision of the M descriptors in the forthcoming (seventh) edition of the TNM classification of lung cancer
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DOI：
10.1097/jto.0b013e31811f4703
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发表时间：
2007-08-01
影响因子：
20.4
通讯作者：
Yokomise, Hiroyasu
中科院分区：
文献类型：
--
作者：
Postmus, Pieter E.;Brambilla, Elisabeth;Yokomise, Hiroyasu
目的：分析当前肺癌TNM系统中所有非淋巴转移成分(T4和M1)，为下一版肺癌TNM分类提供建议。材料和方法：将100809例肺癌患者的资料提交给国际肺癌研究协会国际数据库。在这些患者中，5592名入选的T4M0和MI患者符合分析的纳入标准。临床分期为T4(病变与原发肿瘤不连续)和MI患者的特定类别的患者的总体生存率采用Kaplan-Meier生存估计法进行比较，并通过Cox回归分析进行比较。结果：恶性胸腔积液cT4M0患者的中位生存期显著低于其他cT4M0患者(8个月比13个月)，与仅有对侧肺转移的MI患者(10个月)比较，差异有统计学意义(P<0.05)。肺/胸膜外转移的MI患者预后明显差于仅限于肺内转移的患者，中位生存期为6个月。结论：修订的TNM肺癌分类系统应将恶性胸腔积液和对侧肺内结节分为M1a类，远处转移的病例应指定为MLB。此外，根据IASLC国际分期委员会T描述符小组委员会的建议，同侧肺(非主叶)结节(S)目前分期为M1的病例应重新分类为T4M0。
Purpose: To analyze all nonlymphatic metastatic components (T4 and M1) of the current TNM system of lung cancer, with the objective of providing suggestions for the next edition of the TNM classification for lung cancer.Material and Methods: Data on 100,809 patients were submitted to the International Association for the Study of Lung Cancer Intemational Database. Of these, 5592 selected T4M0 and MI patients fulfilled the inclusion criteria for the analysis. Specific categories of clinically staged T4 (lesions not continuous with the primary tumor) and MI cases were compared with respect to overall survival using Kaplan-Meier survival estimates and comparisons via Cox regression analysis. Relevant findings were validated internally by geographic area and type of database and were validated externally by the North American Surveillance, Epidemiology and End Results Registries.Results: Median survival for cT4M0 with malignant pleural effusion was significantly worse than that of other cT4M0 patients (8 months versus 13 months) and was more comparable with M I cases with metastases to the contralateral lung only (10 months). M I cases with metastases outside the lung/pleura had a significantly poorer prognosis than those with metastases confined to the lung, with a median survival of 6 months.Conclusions: Revisions to the TNM classification system for lung cancer should include grouping cases with malignant pleural effusions and cases with nodules in the contralateral lung in the M1a category, and cases with distant metastases should be designated Mlb. In addition, cases with nodule(s) in the ipsilateral lung (nonprimary lobe), currently staged M 1, should be reclassified as T4M0, in accordance with the recommendations of the T descriptor subcommittee of the IASLC international staging committee.