Dept of Clinical and Registry-based Research, Cancer Registry of Norway, Oslo, Norway.
Eur Respir J. 2010 Aug;36(2):401-7. doi: 10.1183/09031936.00171809. Epub 2010 Jan 14.
Our study describes the new seventh edition of the TNM system for lung cancer in a national population and its clinical implications. We classified 1,885 operated patients with lung cancer, reported to the Cancer Registry of Norway (Oslo, Norway) from 2001 to 2005, according to the sixth and the seventh edition of the TNM system. We compared survival differences adjusting for known prognostic factors. Furthermore, we evaluated the overall predictive ability of both editions using Harrell's concordance index. Survival curves by stage for each of the editions were similar; however, a better description of stage IIIB was observed in the seventh edition. Survival rates of T1b and T2a tumours were similar (log rank p = 0.94). The concordance index was 0.68 for both editions, indicating no overall difference in their predictive accuracy. In the seventh edition, 211 (29%) stage IB patients migrated to stage II and 161 (48%) patients migrated from stage IIB to IIA. Stage migrations could change the treatment for up to 326 (17.3%) of the study patients. The seventh edition did not improve the overall predictive ability of the TNM system; however, the new classification implies changes in treatment for nearly one-fifth of the cases. The implications of the seventh TNM edition for the outcomes of patients should be studied further.
我们的研究描述了第七版肺癌 TNM 系统在全国人群中的应用及其临床意义。我们根据第六版和第七版 TNM 系统，对 2001 年至 2005 年向挪威癌症登记处（挪威奥斯陆）报告的 1885 例手术治疗的肺癌患者进行了分类。我们调整了已知预后因素后比较了生存差异。此外，我们使用 Harrell 一致性指数评估了两个版本的整体预测能力。两个版本的各期别生存曲线相似，但第七版对 IIIB 期的描述更为准确。T1b 和 T2a 肿瘤的生存率相似（对数秩检验 p = 0.94）。两个版本的一致性指数均为 0.68，表明其预测准确性没有总体差异。在第七版中，211 名（29%）IA 期患者转移到 II 期，161 名（48%）IB 期患者从 IIB 期转移到 IIA 期。分期迁移可能会改变多达 326 名（17.3%）研究患者的治疗方案。第七版并没有提高 TNM 系统的整体预测能力；然而，新的分类方案意味着近五分之一的病例需要改变治疗方案。第七版 TNM 系统对患者结局的影响还需要进一步研究。
