Haraguchi Shuji, Koizumi Kiyoshi, Akiyama Hirohiko, Mikami Iwao, Okada Daisuke, Yoshino Naoyuki, Shimizu Kazuo
Division of Thoracic Surgery, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(6):559-64. doi: 10.5761/atcs.oa.11.01692. Epub 2011 Aug 26.
We investigated the validation of the seventh edition of the TNM staging (2009) system for lung cancer, retrospectively.
From January 1990 to March 2004, 1629 patients who underwent lung resection with systemic lymph node dissection for non-small cell lung cancer at Nippon Medical School and Saitama Cancer Center were included. The overall survivals after surgery by each pathological stage according to the 1997 and 2009 systems were statistically analyzed using Kaplan-Meier estimated survival curves, and the significance of the difference was analyzed by the log-rank test.
The 2009 system had significant prognostic distinction between each T descriptor except for T2a and T2b, and between each M descriptor. The 2009 system had better prognostic distinction between each pathological stage except for stages IB and IIA, and stages IIIB and IV. In the simulation, we unified T2a and T2b tumors into T2 tumors, and T2bN0M0 and T2bN1M0 were moved to stages IB and IIA, respectively. This proposed system had significant prognostic distinction between the proposed IB, IIA, and IIB stages.
The 2009 system provides better patient selection for surgery and prognostic distinction between each stage except for stages IB and IIA, and stages IIIB and IV, compared with the 1997 system. Unification of T2a and T2b tumors to T2 tumors can improve prognostic distinction between stages IB and IIA.
我们回顾性地研究了肺癌TNM分期系统（2009年第七版）的有效性。
纳入1990年1月至2004年3月期间在日本医科大学和埼玉癌症中心接受非小细胞肺癌肺切除及系统性淋巴结清扫术的1629例患者。采用Kaplan-Meier估计生存曲线对1997年和2009年系统各病理分期术后的总生存率进行统计学分析，并通过对数秩检验分析差异的显著性。
2009年系统除T2a和T2b外，各T描述符之间以及各M描述符之间具有显著的预后差异。2009年系统除IB期和IIA期以及IIIB期和IV期外，各病理分期之间具有更好的预后差异。在模拟中，我们将T2a和T2b肿瘤统一为T2肿瘤，T2bN0M0和T2bN1M0分别转移至IB期和IIA期。该提议系统在提议的IB期、IIA期和IIB期之间具有显著的预后差异。
与1997年系统相比，2009年系统在手术患者选择方面以及除IB期和IIA期以及IIIB期和IV期外的各阶段预后差异方面表现更佳。将T2a和T2b肿瘤统一为T2肿瘤可改善IB期和IIA期之间的预后差异。
