van Rens M T, de la Rivière A B, Elbers H R, van Den Bosch J M
Departments of Pulmonary Diseases, Sint Antonius Hospital, Nieuwegein, The Netherlands.
Chest. 2000 Feb;117(2):374-9. doi: 10.1378/chest.117.2.374.
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.
Retrospective study; period from 1970 to 1992; follow-up > or = 5 years.
A total of 2,361 previously untreated patients who underwent resection for stage I, II, or IIIA primary NSCLC.
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.
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.
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.
肺癌的分期和分类对于患者管理及临床研究均很重要。分析原发性非小细胞肺癌（NSCLC）患者切除术后的生存结果，以验证分期系统最近的改进。
回顾性研究；时间段为1970年至1992年；随访≥5年。
总共2361例既往未接受过治疗的患者，他们接受了I期、II期或IIIA期原发性NSCLC的切除术。
采用Kaplan-Meier生存分析方法从手术日期开始估计生存情况。排除手术30天内的死亡病例。通过对数秩检验分析不同手术病理TNM分类（基于切除标本的病理检查）以及进一步的鉴别因素的生存比较。
3.9%的患者发生术后死亡。进行生存分析时纳入了2263例患者。总体5年生存率为937/2263（41.4%）。IA期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期之间未显示出生存差异。术后4年内，手术年龄不影响生存；5年后，65岁以上患者的生存率显著较低。
TNM分期系统准确反映了原发性NSCLC的预后，但某些分期定义仍可探讨。尽管分期系统基于临床数据构建，但本分析纳入了术后数据，证实了T2N0M0和T1N1M0患者的生存情况相似。这些结果还强调了使用两个单独的亚分期，特别是因为这些患者尽可能接受了手术。
