Kassis Edmund S, Vaporciyan Ara A, Swisher Stephen G, Correa Arlene M, Bekele B Nebiyou, Erasmus Jeremy J, Hofstetter Wayne L, Komaki Ritsuko, Mehran Reza J, Moran Cesar A, Pisters Katherine M, Rice David C, Walsh Garrett L, Roth Jack A
Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4095, USA.
J Thorac Cardiovasc Surg. 2009 Aug;138(2):412-418.e1-2. doi: 10.1016/j.jtcvs.2009.01.033. Epub 2009 May 28.
The International Association for the Study of Lung Cancer (IASLC) proposed a revision to the Union Internationale Contre le Cancer (UICC-6) staging system for non-small cell lung cancer. The goal of our study was to compare these systems in patients undergoing surgery for non-small cell lung cancer to determine whether one system is superior in staging operable disease.
Pathologic stages in 1154 patients undergoing complete resection over a 9-year period were analyzed. Patients were assigned a stage based on both IASLC and UICC-6 systems. We tested for statistically meaningful differences between the two staging systems using the Wilcoxon signed rank test and the permutation test.
The IASLC system is more effective than the UICC-6 system at ordering and differentiating patients (P = .009). Application of the IASLC system resulted in 202 (17.5%) patients being reassigned to a different stage (P = .012), with the most common shifts occurring from IB to IIA and IIIB to IIIA. The 5-year and median survivals of the IASLC IIIA patients including those shifted from the UICC-6 IIIB were 37% and 35 months, respectively. Reclassifying UICC-6 IIIB to IASLC IIIA did not reduce survival for the newly characterized IIIA cohort.
Our data confirm that the proposed IASLC staging system is more effective at differentiating stage than the UICC-6 system. Reclassifying patients from UICC-6 IIIB to IASLC IIIA will shift some patients from a stage previously considered unresectable to a stage frequently offered surgical resection. Further study and validation of the IASLC system are warranted.
国际肺癌研究协会（IASLC）提议对国际抗癌联盟（UICC - 6）非小细胞肺癌分期系统进行修订。我们研究的目的是比较这两种系统在接受非小细胞肺癌手术患者中的应用情况，以确定哪种系统在对可手术疾病进行分期方面更具优势。
分析了9年间1154例接受根治性切除患者的病理分期。根据IASLC和UICC - 6系统对患者进行分期。我们使用Wilcoxon符号秩检验和置换检验来检测两种分期系统之间是否存在统计学上的显著差异。
在对患者进行排序和区分方面，IASLC系统比UICC - 6系统更有效（P = 0.009）。应用IASLC系统导致202例（17.5%）患者被重新分配到不同分期（P = 0.012），最常见的转变是从IB期变为IIA期以及从IIIB期变为IIIA期。包括那些从UICC - 6的IIIB期转变而来的IASLC IIIA期患者，其5年生存率和中位生存期分别为37%和35个月。将UICC - 6的IIIB期重新分类为IASLC的IIIA期并没有降低新分类的IIIA期队列的生存率。
我们的数据证实，提议的IASLC分期系统在区分分期方面比UICC - 6系统更有效。将患者从UICC - 6的IIIB期重新分类为IASLC的IIIA期将使一些患者从先前被认为不可切除的分期转变为经常进行手术切除的分期。IASLC系统值得进一步研究和验证。
