Curran W J, Cox J D, Azarnia N, Byhardt R W, Shin K H, Emani B, Phillips T L, Selim H, Herskovic A, Mohiuddin M
Fox Chase Cancer Center, Philadelphia, PA 19111.
Cancer. 1991 Aug 1;68(3):509-16. doi: 10.1002/1097-0142(19910801)68:3<509::aid-cncr2820680311>3.0.co;2-7.
Since 1973, the Radiation Therapy Oncology Group (RTOG) has staged and stratified patients in non-small cell lung cancer (NSCLC) protocols according to the RTOG staging system. In 1985, the American Joint Committee on Cancer (AJCC) revised its lung cancer staging system, with the principle differences from the RTOG system being the staging of involvement of the chest wall and of contralateral mediastinal and hilar lymph nodes. To determine if the AJCC system discriminated outcome differently than the RTOG system in a nonoperative series, all 850 evaluable patients treated with hyperfractionated radiation therapy (RT) on the RTOG protocol 83-11 were restaged by the AJCC system. There was 67% agreement in patient distribution between the following comparable stages in each system: RTOG Stage II/AJCC Stage II; RTOG Stage III/AJCC Stage IIIA; and RTOG Stage IV/AJCC Stage IIIB. Both systems successfully predicted for survival (P less than 0.001), although the RTOG staging was more discriminating (relative risk ratios, 1.59 versus 1.38). Among the 507 favorable patients (those with less than or equal to 5% weight loss and Karnofsky performance status [KPS] of 70 to 100), the RTOG staging was also more predictive (P = 0.004 versus P = 0.01). When RTOG Stage III (462 patients) was divided into those without contralateral mediastinal or hilar adenopathy (AJCC Stage II/IIIA) and those with (AJCC Stage IIIB), a significant survival (P = 0.0001) was noted with 2-year survival rates of 26% versus 4%, respectively. When AJCC Stage IIIA (348 patients) was divided into the patients without chest wall invasion (RTOG Stage II/III) and those with (RTOG Stage IV), a difference in 2-year survival of 22% versus 10% was observed (P = 0.002). Although both staging systems independently predict for survival, a fusion of both staging systems is the most discriminating of outcome. Future nonoperative studies in locally advanced NSCLC should stratify for contralateral nodal involvement (per AJCC staging) and chest wall invasion (per RTOG staging).
自1973年以来，放射治疗肿瘤学组（RTOG）一直根据RTOG分期系统对非小细胞肺癌（NSCLC）方案中的患者进行分期和分层。1985年，美国癌症联合委员会（AJCC）修订了其肺癌分期系统，与RTOG系统的主要区别在于胸壁受累以及对侧纵隔和肺门淋巴结受累的分期。为了确定在非手术系列中AJCC系统与RTOG系统对预后的区分是否不同，对按照RTOG 83 - 11方案接受超分割放射治疗（RT）的所有850例可评估患者采用AJCC系统重新分期。每个系统中以下可比分期之间的患者分布有67%的一致性：RTOG II期/AJCC II期；RTOG III期/AJCC IIIA期；以及RTOG IV期/AJCC IIIB期。两种系统都成功地预测了生存率（P小于0.001），尽管RTOG分期更具区分性（相对风险比，1.59对1.38）。在507例情况较好的患者（体重减轻小于或等于5%且卡诺夫斯基功能状态[KPS]为70至100）中，RTOG分期也更具预测性（P = 0.004对P = 0.01）。当将RTOG III期（462例患者）分为无对侧纵隔或肺门淋巴结肿大的患者（AJCC II/IIIA期）和有对侧纵隔或肺门淋巴结肿大的患者（AJCC IIIB期）时，观察到显著的生存率差异（P = 0.0001），2年生存率分别为26%和4%。当将AJCC IIIA期（348例患者）分为无胸壁侵犯的患者（RTOG II/III期）和有胸壁侵犯的患者（RTOG IV期）时，观察到2年生存率差异为22%对10%（P = 0.002）。尽管两种分期系统都能独立预测生存率，但两种分期系统的融合对预后的区分最为明显。未来针对局部晚期NSCLC的非手术研究应根据对侧淋巴结受累情况（按照AJCC分期）和胸壁侵犯情况（按照RTOG分期）进行分层。
