Jung Hee Suk, Lee Jin Gu, Lee Chang Young, Kim Dae Joon, Chung Kyung Young
Department of Thoracic and Cardiovascular Surgery, CHA Bundang Medical Center, CHA University, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Yonsei University, College of Medicine, Seoul, Korea.
J Thorac Dis. 2018 Jan;10(1):162-167. doi: 10.21037/jtd.2017.12.20.
To validate new proposals for the revision of T descriptors and to compare the prognostic value of the seventh and forthcoming eighth edition of the tumor, node and metastasis (TNM) classification for lung cancer.
A retrospective analysis was conducted of 1,316 patients with non-small lung cancer who underwent pulmonary resection between 1999 and 2012. Patients who had a positive nodal status or distant metastasis were excluded. We classified these patients according to the seventh and eighth edition of the TNM system, and analyzed differences in stage specific survival. Harrell's concordance (C)-index and Heagerty's integrated area under the curve (iAUC) were used to assess the overall predictive ability of the different TNM versions.
There were no significant survival differences between each stage based on the T stage criteria of the eighth edition, most notably between T1a and T1b (P=0.752), and T1c, T2a, and T2b (P=0.832). The C-indices of the classification based on the seventh and eighth edition were 0.681 and 0.675, respectively. There was no significant difference in the C-indices between the seventh and eighth edition. The iAUC value for overall survival of the seventh and eighth staging editions was 0.637 and 0.631, respectively. The differences in iAUC between the seventh and eighth editions were also not statistically significant.
The newly proposed T descriptors in the eighth TNM classification system did not allow a more accurate prediction of prognosis compared with the current seventh edition in our population.
验证修订T描述符的新提议，并比较肺癌肿瘤、淋巴结转移（TNM）分类第七版和即将推出的第八版的预后价值。
对1999年至2012年间接受肺切除术的1316例非小细胞肺癌患者进行回顾性分析。排除有阳性淋巴结状态或远处转移的患者。我们根据TNM系统的第七版和第八版对这些患者进行分类，并分析特定阶段生存率的差异。使用Harrell一致性（C）指数和Heagerty曲线下综合面积（iAUC）评估不同TNM版本的总体预测能力。
根据第八版的T分期标准，各阶段之间的生存率无显著差异，最明显的是T1a和T1b之间（P = 0.752），以及T1c、T2a和T2b之间（P = 0.832）。基于第七版和第八版分类的C指数分别为0.681和0.675。第七版和第八版之间的C指数无显著差异。第七版和第八版分期的总生存iAUC值分别为0.637和0.631。第七版和第八版之间的iAUC差异也无统计学意义。
在我们的研究人群中，与当前的第七版相比，第八版TNM分类系统中新提出的T描述符并不能更准确地预测预后。
