Zell Jason A, Ignatius Ou S-H, Ziogas Argyrios, Anton-Culver Hoda
Genetic Epidemiology Research Institute, Department of Epidemiology, University of California Irvine, Irvine, California, USA.
J Thorac Oncol. 2007 Dec;2(12):1078-85. doi: 10.1097/JTO.0b013e31815ba260.
Recently, the International Association for the Study of Lung Cancer (IASLC) has proposed significant modifications to the existing TNM and stage grouping classifications affecting the T4 and M descriptors. We set out to validate this staging system for bronchioloalveolar carcinoma (BAC) cases using data from the California Cancer Registry (CCR).
We identified 1909 patients from the CCR between 1999 and 2003 with histologically confirmed BAC and complete TNM staging and reclassified them according to the IASLC proposed staging revisions. There were 657 patients with stage IIIB and IV disease who formed the primary analysis of the changes to T4 and M descriptors. Surveillance Epidemiology and End Results (SEER) extent of disease codes (EOD) were used to identify various T4 and M descriptors. The primary outcome measured was overall survival (OS) for stage-specific comparisons of the existing to the proposed staging systems, using the Kaplan-Meier method. Multivariate survival analyses were performed using Cox proportional hazards ratios.
Using the proposed criteria, 162 (25%) of the 657 patients with advanced BAC were reclassified: 73 patients with multiple lesions in the same lobe as T3 (stage II T3N0M0 [n = 53], stage IIIA T3N1-2M0 [n = 18], stage IIIB T3N3M0 [n = 1] or T3NXM0 [n = 1]); 89 patients with ipsilateral intrapulmonary metastasis were reclassified as T4 (stage IIIA T4N0-N1M0 [n = 54], stage IIIB T4N2-3M0 [n = 23] or T4NXM0 [n = 12]). Univariate and multivariate survival analysis of this validation set revealed an improved fit for the proposed IASLC staging system compared with the existing staging system.
The proposed IASLC staging system modifications accurately reflect survival characteristics for BAC and represent an improvement compared with the existing staging system.
最近，国际肺癌研究协会（IASLC）对现有的TNM分期和分组分类提出了重大修改，影响了T4和M描述符。我们着手使用加利福尼亚癌症登记处（CCR）的数据来验证该分期系统在细支气管肺泡癌（BAC）病例中的应用。
我们从CCR中识别出1999年至2003年间1909例经组织学确诊为BAC且TNM分期完整的患者，并根据IASLC提议的分期修订对他们进行重新分类。有657例ⅢB期和Ⅳ期疾病患者构成了对T4和M描述符变化的主要分析对象。使用监测、流行病学和最终结果（SEER）疾病范围编码（EOD）来识别各种T4和M描述符。测量的主要结局是使用Kaplan-Meier方法对现有分期系统与提议分期系统进行特定分期比较的总生存期（OS）。使用Cox比例风险比进行多变量生存分析。
根据提议的标准，657例晚期BAC患者中有162例（25%）被重新分类：73例同一肺叶有多个病灶的患者被重新分类为T3（Ⅱ期T3N0M0 [n = 53]，ⅢA期T3N1-2M0 [n = 18]，ⅢB期T3N3M0 [n = 1]或T3NXM0 [n = 1]）；89例同侧肺内转移患者被重新分类为T4（ⅢA期T4N0-N1M0 [n = 54]，ⅢB期T4N2-3M0 [n = 23]或T4NXM0 [n = 12]）。对该验证集进行单变量和多变量生存分析显示，与现有分期系统相比，提议的IASLC分期系统拟合度更高。
提议的IASLC分期系统修改准确反映了BAC的生存特征，与现有分期系统相比有改进。
