Department of Urology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Urol. 2011 Jun;185(6):2035-9. doi: 10.1016/j.juro.2011.02.059. Epub 2011 Apr 15.
In 2010 the American Joint Committee on Cancer updated the renal cell carcinoma TNM classification. Without independent validation of the new classification its predictive ability for cancer specific survival and generalizability remains unknown. In this setting we determined the predictive ability of the 2010 TNM classification compared to that of the 2002 classification.
Using the nephrectomy registry at our institution we retrospectively reviewed the records of 3,996 patients with unilateral or bilateral synchronous renal cell carcinoma treated with radical nephrectomy or nephron sparing surgery between 1970 and 2006. Cancer specific survival was estimated using the Kaplan-Meier method and predictive ability was evaluated using the concordance index.
There were 1,165 deaths (29.1%) from renal cell carcinoma a median of 1.9 years after surgery compared to a median followup of 7.4 years for survivors. The estimated 10-year cancer specific survival rate was 96%, 80%, 66%, 55%, 36%, 26%, 25% and 12% for patients with 2010 primary tumor classifications of pT1a, pT1b, pT2a, pT2b, pT3a, pT3b, pT3c and pT4, respectively (p <0.001). The multivariate concordance index for the 2002 and 2010 TNM classifications was 0.848 and 0.850, respectively.
The new 2010 classification remains a robust predictor of cancer specific survival compared to the 2002 classification by dividing pT2 lesions into pT2a and pT2b, reclassifying ipsilateral adrenal involvement as pT4, reclassifying renal vein involvement as pT3a and simplifying nodal involvement as pN0 vs pN1. However, the 2010 TNM classification showed only modest improvement in predictive ability compared to the 2002 classification.
2010 年，美国癌症联合委员会更新了肾细胞癌 TNM 分类。由于新分类未经独立验证，其对癌症特异性生存的预测能力及其通用性仍不得而知。在这种情况下，我们确定了 2010 年 TNM 分类与 2002 年分类的预测能力。
利用我们机构的肾切除术登记处，我们回顾性地审查了 1970 年至 2006 年间接受根治性肾切除术或保留肾单位手术治疗的单侧或双侧同步肾细胞癌患者的 3996 例记录。使用 Kaplan-Meier 方法估计癌症特异性生存率，并使用一致性指数评估预测能力。
共有 1165 例（29.1%）死于肾细胞癌，术后中位数为 1.9 年，而幸存者的中位随访时间为 7.4 年。2010 年原发肿瘤分类为 pT1a、pT1b、pT2a、pT2b、pT3a、pT3b、pT3c 和 pT4 的患者，估计 10 年癌症特异性生存率分别为 96%、80%、66%、55%、36%、26%、25%和 12%（p<0.001）。2002 年和 2010 年 TNM 分类的多变量一致性指数分别为 0.848 和 0.850。
与 2002 年分类相比，新的 2010 年分类通过将 pT2 病变分为 pT2a 和 pT2b、将同侧肾上腺受累重新分类为 pT4、将肾静脉受累重新分类为 pT3a 以及简化淋巴结受累为 pN0 与 pN1，仍然是癌症特异性生存的有力预测指标。然而，与 2002 年分类相比，2010 年 TNM 分类的预测能力仅略有提高。
