Liang Guanghui, Gu Zhitao, Li Yin, Fu Jianhua, Shen Yi, Wei Yucheng, Tan Lijie, Zhang Peng, Han Yongtao, Chen Chun, Zhang Renquan, Chen Keneng, Chen Hezhong, Liu Yongyu, Cui Youbing, Wang Yun, Pang Liewen, Yu Zhentao, Zhou Xinming, Liu Yangchun, Liu Yuan, Fang Wentao
1 Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China ; 3 Department of Thoracic Surgery, Guangdong Esophageal Cancer Institute, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China ; 4 Department of Thoracic Surgery, Affiliated Hospital of Qingdao University, Qingdao 266001, China ; 5 Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 6 Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, China ; 7 Department of Thoracic Surgery, Sichuan Cancer Hospital, Chengdu 610041, China ; 8 Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China ; 9 Department of Thoracic Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China ; 10 Department of Thoracic Surgery, Beijing Cancer Hospital, Beijing 100142, China ; 11 Department of Cardiothoracic Surgery, Changhai Hospital, Shanghai 200433, China ; 12 Department of Thoracic Surgery, Liaoning Cancer Hospital, Shenyang 110042, China ; 13 Department of Thoracic Surgery, First Affiliated Hospital of Jilin University, Changchun 130021, China ; 14 Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China ; 15 Department of Thoracic Surgery, Huashan Hospital, Fudan University, Shanghai 200032, China ; 16 Department of Esophageal Cancer, Tianjin Cancer Hospital, Tianjin 300060, China ; 17 Department of Thoracic Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China ; 18 Department of Thoracic Surgery, Jiangxi People's Hospital, Nanchang 330006, China.
J Thorac Dis. 2016 Apr;8(4):727-37. doi: 10.21037/jtd.2016.03.22.
To compare the predictive effect of the Masaoka-Koga staging system and the International Association for the Study of Lung Cancer (IASLC)/the International Thymic Malignancies Interest Group (ITMIG) proposal for the new TNM staging on prognosis of thymic malignancies using the Chinese Alliance for Research in Thymomas (ChART) retrospective database.
From 1992 to 2012, 2,370 patients in ChART database were retrospectively reviewed. Of these, 1,198 patients with complete information on TNM stage, Masaoka-Koga stage, and survival were used for analysis. Cumulative incidence of recurrence (CIR) was assessed in R0 patients. Overall survival (OS) was evaluated both in an R0 resected cohort, as well as in all patients (any R status). CIR and OS were first analyzed according to the Masaoka-Koga staging system. Then, they were compared using the new TNM staging proposal.
Based on Masaoka-Koga staging system, significant difference was detected in CIR among all stages. However, no survival difference was revealed between stage I and II, or between stage II and III. Stage IV carried the highest risk of recurrence and worst survival. According to the new TNM staging proposal, CIR in T1a was significantly lower comparing to all other T categories (P<0.05) and there is a significant difference in OS between T1a and T1b (P=0.004). T4 had the worst OS comparing to all other T categories. CIR and OS were significantly worse in N (+) than in N0 patients. Significant difference in CIR and OS was detected between M0 and M1b, but not between M0 and M1a. OS was almost always statistically different when comparison was made between stages I-IIIa and stages IIIb-IVb. However, no statistical difference could be detected among stages IIIb to IVb.
Compared with Masaoka-Koga staging, the IASLC/ITMIG TNM staging proposal not only describes the extent of tumor invasion but also provides information on lymphatic involvement and tumor dissemination. Further study using prospectively recorded information on the proposed TNM categories would be helpful to better grouping thymic tumors for predicting prognosis and guiding clinical management.
利用中国胸腺瘤研究联盟（ChART）回顾性数据库，比较Masaoka-Koga分期系统与国际肺癌研究协会（IASLC）/国际胸腺恶性肿瘤兴趣小组（ITMIG）提出的新TNM分期对胸腺恶性肿瘤预后的预测效果。
回顾性分析1992年至2012年ChART数据库中的2370例患者。其中，1198例具有完整TNM分期、Masaoka-Koga分期及生存信息的患者纳入分析。评估R0患者的复发累积发生率（CIR）。在R0切除队列以及所有患者（任何R状态）中评估总生存期（OS）。首先根据Masaoka-Koga分期系统分析CIR和OS。然后，使用新的TNM分期建议进行比较。
基于Masaoka-Koga分期系统，各期之间CIR存在显著差异。然而，I期和II期之间或II期和III期之间未显示出生存差异。IV期复发风险最高，生存最差。根据新的TNM分期建议，T1a期的CIR显著低于所有其他T类别（P<0.05），且T1a期和T1b期之间的OS存在显著差异（P=0.004）。与所有其他T类别相比，T4期的OS最差。N（+）患者的CIR和OS显著差于N0患者。M0和M1b之间的CIR和OS存在显著差异，但M0和M1a之间无差异。I-IIIa期和IIIb-IVb期之间进行比较时，OS几乎总是存在统计学差异。然而，IIIb期至IVb期之间未检测到统计学差异。
与Masaoka-Koga分期相比，IASLC/ITMIG的TNM分期建议不仅描述了肿瘤侵犯范围，还提供了有关淋巴受累和肿瘤播散的信息。使用前瞻性记录的拟议TNM类别的信息进行进一步研究，将有助于更好地对胸腺肿瘤进行分组，以预测预后并指导临床管理。
