小细胞肺癌TNM分类第八版的外部验证

2022-04-13 13:11

本研究为第八版中国小细胞肺癌患者的临床分期提供了外部验证，并证实其预后准确性较第七版有所提高。N3和M1B患者可能代表着需要进一步研究的不同人群。

SCI

12 April 2022

_{External Validation of the Eighth Edition of the TNM Classification for Lung Cancer in Small Cell Lung Cancer}

_{（Lung Cancer IF：5.7046）}

Fengwei Tan, Nan Bi, Hao Zhang, Renda Li, Zhijie Wang, Jianchun Duan, Feng Jiang, Dongjie Feng, Rongsheng Zhang, Junjun Bai, Jianzhong Cao, Naiquan Mao, Kai Liang, Shiquan Yin, Yaxing Shen, Feiyue Feng, Jun Zhao, Yushun Gao, Yousheng Mao, Qi Xue, Shugeng Gao, Jie He,Lung Cancer,2022.

Objectives 目的

The newly released eighth edition of the American Joint Committee on Cancer TNM staging system for lung cancer seeks to improve prognostic accuracy but lacks external validation for small cell lung cancer (SCLC). Moreover, previous studies posed a few questions concerning survival differences for patients with specific site N3 node involvement or single-site metastasis (SSM) in different distant organs. The aim of this study was to validate the eighth edition of the TNM classification for SCLC in an independent multi-institutional cohort from China and answer the questions raised by the previous research.

最新发布的第八版美国癌症联合委员会肺癌TNM分期系统旨在提高小细胞肺癌(SCLC)的预后准确性，但缺乏外部验证。此外，以前的研究提出了一些关于特定部位N3结节受累或不同远处器官单部位转移(SSM)患者的生存差异的问题。本研究的目的是在中国独立的多机构队列中验证第八版小细胞肺癌TNM分类，并回答先前研究提出的问题。

Methods 方法

Patients with SCLC from four Chinese cancer centers between 2009 and 2019 were reclassified according to the seventh and eighth edition of the TNM classification. Survival was estimated using the Kaplan-Meier method. Comparisons between adjacent categories and stage groups were performed using Cox proportional hazard regression. R2 statistics were calculated to evaluate the discriminating performance of editions.

2009年至2019年来自中国四个癌症中心的小细胞肺癌患者按第七版和第八版TNM分类进行重新分类。生存估计采用Kaplan-Meier方法。相邻组间和分期组间的比较采用COX比例风险回归。

Results 结果

Of 3384 enrolled cases, 3358 had clinical stage, 537 had pathological stage, and 511 had both. Progressive deterioration of survival was observed with advancing of TNM categories and stages both in the seventh and the eighth edition. The eighth edition stages had a higher R2 statistic than the seventh edition (0.207 versus 0.197). Newly defined categories M1b and M1c and stages IIIC, IVA and IVB in the eighth edition discriminated groups with significantly different prognosis. Patients with N3 contralateral supraclavicular nodes had a significantly worse prognosis than those without (p = 0.032). For patients with single-site metastasis, liver involvement showed a worse prognosis compared to brain involvement (p = 0.030).

3384例入选病例中，临床分期3358例，病理分期537例，两者兼有511例。在第七版和第八版中，随着TNM分类和分期的推进，生存期逐渐恶化。第八版的R2统计量高于第七版(0.207比0.197)。第八版新定义的M1B、M1c和IIIC、IVA、IVB三期预后差异有统计学意义。有N3对侧锁骨上结节的患者预后明显差于无N3对侧锁骨上淋巴结的患者(p=0.032)。对于单部位转移的患者，肝脏受累的预后比脑受累的患者差(p=0.030)。

Conclusions 结论

Our study provided an external validation of the eighth edition of the TNM classification for lung cancer in Chinese patients with SCLC, and confirmed its improved prognostic accuracy compared with the seventh edition. Patients with N3 and M1b might represent heterogeneous populations that warrant further research.