Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK.
J Clin Pathol. 2012 Apr;65(4):367-71. doi: 10.1136/jclinpath-2011-200468. Epub 2012 Jan 28.
The TNM classification for renal cell cancer (RCC) should accurately predict and assign prognostic information for patients. In this study the recent 2010 revision to the TNM classification was compared with the previous 2002 classification with regard to survival outcomes.
All patients having radical nephrectomy for RCC in the 5-year period 2004-8 at a tertiary referral centre were included. Pathological and radiological records were reviewed to identify TNM stage (2002 and 2010 classification) and survival data were captured.
345 patients with RCC were identified. Based on the 2002 TNM staging system and using outcomes in T1 staged tumours as a baseline, statistically significant differences in disease-specific survival were noted between patients with T1 and T3b tumours (log rank p<0.001) but not between those with T1 and T3a tumours (p=0.33). However, when tumour stage was reassigned according to the 2010 classification, patients with T3a tumours were also found to do statistically worse than T1 staged disease (p<0.001).
In our cohort, the new 2010 TNM reclassification of T3 tumours showed better correlation with predicting worsening outcomes compared with localised disease.
肾细胞癌（RCC）的 TNM 分类应准确预测并为患者分配预后信息。本研究比较了 2010 年最新版 TNM 分类与之前的 2002 年分类在生存结果方面的差异。
所有在 2004 年至 2008 年的 5 年期间在三级转诊中心接受根治性肾切除术的 RCC 患者均被纳入研究。回顾病理和影像学记录以确定 TNM 分期（2002 年和 2010 年分类）和生存数据。
共确定了 345 例 RCC 患者。根据 2002 年 TNM 分期系统，以 T1 期肿瘤的结局为基线，T1 和 T3b 期肿瘤患者的疾病特异性生存率存在显著差异（对数秩检验 p<0.001），但 T1 和 T3a 期肿瘤患者之间无显著差异（p=0.33）。然而，当根据 2010 年分类重新分期肿瘤时，T3a 期肿瘤患者的预后也明显差于 T1 期疾病（p<0.001）。
在我们的队列中，新的 2010 年 T 分期的 TNM 再分类与预测疾病恶化结局的相关性优于局限性疾病。
