Validation of the 8th edition of the TNM staging system in 3,950 patients with surgically resected non-small cell lung cancer
Validation of the 8th edition of the TNM staging system in 3,950 patients with surgically resected non-small cell lung cancer
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DOI：
10.21037/jtd.2019.07.43
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发表时间：
2019-07-01
影响因子：
2.5
通讯作者：
Choi, Sehoon
中科院分区：
文献类型：
--
作者：
Yun, Jae Kwang;Lee, Geun Dong;Choi, Sehoon
背景：国际肺癌研究协会推出了第八版肺癌肿瘤、淋巴结和转移（TNM）分期系统。在本研究中，我们验证了第8版TNM分期系统，并将其区分能力与之前的第7版进行了比较。方法：对2006年至2015年在韩国首尔三级转诊中心接受系统性淋巴结清扫术的非小细胞肺癌（NSCLC）患者进行回顾性分析。 Cox 回归模型用于识别相邻 TNM 分期分组之间的显着差异。使用一致性指数（C-index）、Akaike信息标准（AIC）和R2测量来评估分期系统的辨别能力。结果：总共分析了3,950名患者（2,440名男性，中位年龄：63岁）。中位随访时间为 59 个月（四分位数范围，38-88 个月）。根据第8版，相邻分期组内的总生存期（OS）和无复发生存期（RFS）的生存曲线除IIA与IIB外均显示出显着差异。与第7版相比，第8版显示出更高的C指数（0.753 vs. 0.751）、更低的AIC（17,517 vs. 17,543）和更高的R2值（0.178 vs. 0.171），表明更好的判别能力。结论：与第7版相比，基于第8版TNM分期系统的分层显示出良好的预后效度版。第8版在OS和RFS方面也具有超强的辨别能力。
Background: The International Association for the Study of Lung Cancer introduced the 8th edition of the tumor, node, and metastasis (TNM) staging system for lung cancer. In this study, we validated the 8th edition of the TNM staging system and compared its discrimination power with that of the previous 7th edition.Methods: A retrospective analysis was carried out on patients who underwent complete resection with systematic lymph node dissection for non-small cell lung cancer (NSCLC) between 2006 and 2015 at a tertiary referral center in Seoul, South Korea. Cox regression model was used to identify significant differences between adjacent TNM stage groupings. The Concordance index (C-index), Akaike Information Criterion (AIC), and R2 measure were utilized to evaluate the discrimination ability of the staging systems.Results: A total of 3,950 patients (2,440 male, median age: 63 years) were analyzed. Median follow-up was 59 months (interquartile ranges, 38-88 months). According to the 8th edition, survival curves of overall survival (OS) and recurrence-free survival (RFS) within adjacent stage groupings showed significant differences except for IIA vs. IIB. Compared with the 7th edition, the 8th edition showed higher C-index (0.753 vs. 0.751), lower AIC (17,517 vs. 17,543), and higher R2 (0.178 vs. 0.171) values, indicating better discrimination ability.Conclusions: Stratification based on the 8th edition of the TNM staging system showed favorable prognostic validity compared with the 7th edition. The 8th edition also had superior discrimination ability in terms of OS and RFS.