Department of Thoracic Surgery, Lung Functional Unit, Hospital Universitari de Bellvitge and Hospital Duran i Reynals-Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain.
Eur J Cardiothorac Surg. 2010 Mar;37(3):540-5. doi: 10.1016/j.ejcts.2009.07.026. Epub 2009 Aug 21.
Accurate preoperative staging is essential to provide the best treatment for lung cancer. The objective of the present study was to determine agreement between preoperative and surgical-pathological staging and to analyse the impact of any disparity on treatment.
This is a descriptive study of a series of 176 lung cancer cases treated by surgery between 2005 and 2007. Preoperative staging was based on clinical information and computed tomography (CT), positron emission tomography (PET), PET-CT, bronchoscopy and mediastinoscopy. In all cases, surgical-pathological staging was based on the analysis of surgical samples and the findings during surgery. Both preoperative and pathological stage determination were based on the TNM (tumour, node, metastasis) classification established in 1997. Concordance was measured by calculating agreement rates and the kappa value.
Preoperative and surgical-pathological staging agreed in 102 cases, an agreement rate of 58% and kappa value of 0.54 (95% confidence interval (CI) 0.44-0.63). The highest kappa value (0.68, 95% CI 0.53-0.82) was obtained in stage IA patients. Patients who underwent PET or PET-CT had a better kappa index (0.56, 95% CI 0.45-0.67, vs 0.39, 95% CI 0.21-0.56). Surgical-pathological staging validated surgery in 145 cases (82%), while 21 (12%) were revised to stage IIIA N2 and 10 (6%) to non-surgical stages.
Global agreement between preoperative and surgical-pathological staging was moderate. The best agreement was found in stages IV and IA.
准确的术前分期对于为肺癌患者提供最佳治疗至关重要。本研究的目的是确定术前和手术病理分期之间的一致性，并分析任何差异对治疗的影响。
这是一项对 2005 年至 2007 年间接受手术治疗的 176 例肺癌病例的描述性研究。术前分期基于临床信息和计算机断层扫描（CT）、正电子发射断层扫描（PET）、PET-CT、支气管镜和纵隔镜检查。在所有病例中，手术病理分期均基于手术样本分析和手术期间的发现。术前和病理分期均基于 1997 年建立的 TNM（肿瘤、淋巴结、转移）分类。通过计算一致性率和kappa 值来衡量一致性。
102 例患者的术前和手术病理分期一致，一致性率为 58%，kappa 值为 0.54（95%置信区间（CI）0.44-0.63）。IA 期患者的 kappa 值最高（0.68，95%CI 0.53-0.82）。接受 PET 或 PET-CT 的患者具有更好的 kappa 指数（0.56，95%CI 0.45-0.67，vs 0.39，95%CI 0.21-0.56）。手术病理分期在 145 例（82%）患者中验证了手术，21 例（12%）患者被修订为 IIIA N2 期，10 例（6%）患者被修订为非手术期。
术前和手术病理分期之间的总体一致性为中度。IA 期和 IV 期的一致性最好。
