Liu Q-X, Deng X-F, Zhou D, Li J-M, Min J-X, Dai J-G
Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
Department of Thoracic Surgery, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China.
Eur J Surg Oncol. 2016 Nov;42(11):1707-1713. doi: 10.1016/j.ejso.2016.03.012. Epub 2016 Mar 30.
In the 7th tumor, node, metastasis (TNM) classification, T1 tumors with visceral pleural invasion (VPI) are upgraded to T2a. The objective of this study was to evaluate the prognostic impact of VPI among patients with NSCLC and to propose a method of incorporating VPI into T-status classification in future staging systems.
A systematic electronic search was conducted from each database's date of inception to October 2015. The included studies were selected according to predefined inclusion criteria. The hazard ratio (HR) was used as the outcome measure for data combining.
A total of 22 studies, published from 2003 to 2015, were included in this meta-analysis. In the subgroup analysis, we identified that VPI was a poor prognostic factor for tumor size ≤2 cm (2.34 [95% confidence interval (CI) 1.55-3.54; P < 0.0001]), 2-3 cm (1.81 [95% CI 1.56-2.10; P < 0.0001]), 3-5 cm (1.61 [95% CI 1.38-1.87; P < 0.0001]) and 5-7 cm (1.50 [95% CI 1.24-1.82; P < 0.0001]). In addition, we also found that there were no significant differences for the following comparisons of OS: tumor size ≤2 cm with VPI versus 3-5 cm without VPI (1.04 [95% CI 0.83-1.31; P = 0.34]); 2-3 cm with VPI versus 3-5 cm without VPI (1.04 [95% CI 0.96-1.13; P = 0.30]); 3-5 cm with VPI versus 5-7 cm without VPI (0.95 [95% CI 0.78-1.17; P = 0.66]); and 5-7 cm with VPI versus T3 status (1.03 [95% CI 0.93-1.14; P = 0.57]).
In addition to the current TNM classification recommendations, consideration should be given to classifying the T2a tumors with VPI as T2b and classifying T2b with VPI as T3 in the next edition of the TNM Classification for Lung cancer.
在第7版肿瘤、淋巴结、转移（TNM）分类中，伴有脏层胸膜侵犯（VPI）的T1期肿瘤被升级为T2a期。本研究的目的是评估VPI对非小细胞肺癌（NSCLC）患者预后的影响，并提出一种在未来分期系统中将VPI纳入T分期分类的方法。
从每个数据库创建之日起至2015年10月进行系统的电子检索。纳入的研究根据预先定义的纳入标准进行选择。风险比（HR）用作数据合并的结果指标。
本荟萃分析共纳入了2003年至2015年发表的22项研究。在亚组分析中，我们发现VPI是肿瘤大小≤2 cm（2.34 [95%置信区间（CI）1.55 - 3.54；P < 0.0001]）、2 - 3 cm（1.81 [95% CI 1.56 - 2.10；P < 0.0001]）、3 - 5 cm（1.61 [95% CI 1.38 - 1.87；P < 0.0001]）和5 - 7 cm（1.50 [95% CI 1.24 - 1.82；P < 0.0001]）患者的不良预后因素。此外，我们还发现，在总生存期（OS）的以下比较中无显著差异：肿瘤大小≤2 cm伴有VPI与3 - 5 cm不伴有VPI（1.04 [95% CI 0.83 - 1.31；P = 0.34]）；2 - 3 cm伴有VPI与3 - 5 cm不伴有VPI（1.04 [95% CI 0.96 - 1.13；P = 0.30]）；3 - 5 cm伴有VPI与5 - 7 cm不伴有VPI（0.95 [95% CI 0.78 - 1.17；P = 0.66]）；以及5 - 7 cm伴有VPI与T3期（1.03 [95% CI 0.93 - 1.14；P = 0.57]）。
除了当前的TNM分类建议外，在肺癌TNM分类的下一版中，应考虑将伴有VPI的T2a期肿瘤分类为T2b期，将伴有VPI的T2b期肿瘤分类为T3期。
