Lyons Gustavo, Quadrelli Silvia, Silva Carlos, Vera Karina, Iotti Alejandro, Venditti Julio, Chertcoff Julio, Chimondeguy Domingo
Centro de Oncología Torácica - Hospital Británico de Buenos Aires Perdriel 74 - Ciudad Autónoma de Buenos Aires, Argentina.
J Thorac Oncol. 2008 Sep;3(9):989-93. doi: 10.1097/JTO.0b013e3181838b19.
The tumor, node, metastasis (TNM) system has been recognized internationally as the standard for staging disease extension, but despite the improvements of the 1997/2002 international staging system, there may be marked differences in postoperative 5-year survival rates within each stage. There is controversy about the impact of tumor size itself as a variable unrelated to stage.The objective of this study was to analyze the influence of tumor size on the survival in patients with surgically resected non-small cell lung carcinoma (NSCLC).
Between August 1985 and January 2006, 400 patients underwent pulmonary resection with a curative intention for non-small cell lung carcinoma. Patients were excluded if they had received neoadjuvant chemotherapy. The clinicopathological records of each patient were examined for prognostic factors such as age, sex, right or left side cancer, histology, tumor location, tumor size, clinical nodal stage number, and distribution of metastatic nodes.
Operative mortality was 2.2% for lobectomy and 18% for pneumonectomy (p < 0.05). Adenocarcinoma was the most common type (n = 245, 61.2%). Surgery was considered a complete resection in 341 patients (85.2%). When only patients without neoplastic hilar or mediastinal metastases (pN0) were included, the difference in survival was significantly different in terms of tumor size (log rank 28.46, p < 0.0001). Univariate analysis for the group of pN0 patients showed survival was not significantly affected by age, sex, side, or adenocarcinoma histology. In the multivariate analysis, tumor size and the T factor were found to have maintained its independent prognostic effects on overall survival. Among patients with pN0 tumors smaller that 15 mm in diameter, 5-year survival was 95% whereas patients with tumors bigger than 16 mm in diameter had a 5-year survival of 65% (p < 0.0001).
In conclusion, our data suggest that tumors over 15 mm are associated with shorter 5-year survival in all TNM stages. Current TNM categories are not sufficiently discriminatory and the T factor requires to be reevaluated in further revisions of the TNM classification.
肿瘤、淋巴结、转移（TNM）系统已被国际公认为疾病分期的标准，但尽管1997/2002年国际分期系统有所改进，各期内术后5年生存率仍可能存在显著差异。肿瘤大小本身作为一个与分期无关的变量所产生的影响存在争议。本研究的目的是分析肿瘤大小对手术切除的非小细胞肺癌（NSCLC）患者生存率的影响。
1985年8月至2006年1月期间，400例患者接受了旨在治愈非小细胞肺癌的肺切除术。接受过新辅助化疗的患者被排除。检查每位患者的临床病理记录，以获取预后因素，如年龄、性别、左右侧癌症、组织学类型、肿瘤位置、肿瘤大小、临床淋巴结分期编号以及转移淋巴结的分布情况。
肺叶切除术的手术死亡率为2.2%，全肺切除术为18%（p<0.05）。腺癌是最常见类型（n = 245，61.2%）。341例患者（85.2%）的手术被视为完全切除。仅纳入无肿瘤肺门或纵隔转移（pN0）的患者时，肿瘤大小在生存率方面存在显著差异（对数秩检验28.46，p<0.0001）。对pN0患者组的单因素分析显示，年龄、性别、肿瘤侧别或腺癌组织学类型对生存率无显著影响。多因素分析发现，肿瘤大小和T因子对总生存率保持独立的预后影响。直径小于15mm的pN0肿瘤患者中，5年生存率为95%，而直径大于16mm的肿瘤患者5年生存率为65%（p<0.0001）。
总之，我们的数据表明，直径超过15mm的肿瘤在所有TNM分期中均与5年生存率较低相关。当前的TNM分类鉴别性不足，在TNM分类的进一步修订中需要重新评估T因子。
