Department of Pulmonary Medicine, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan.
Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Int J Clin Oncol. 2019 Dec;24(12):1549-1557. doi: 10.1007/s10147-019-01525-8. Epub 2019 Aug 26.
In the eighth edition of the TNM classification of lung cancer, the M1b and M1c descriptors are newly defined by the number of extrathoracic metastases. To verify the prognostic value of these descriptors in Japan, we reclassified our cases and re-evaluated prognosis in M1b and M1c patients.
All non-small cell lung cancer (NSCLC) patients with extrathoracic metastases who visited Saitama Medical Center from 2010 to 2016 were evaluated, divided according to the eighth edition of the TNM classification criteria into two groups (M1b, patients with single extrathoracic metastasis, and M1c, patients with multiple extrathoracic metastases), and followed up until December 31, 2017. Survival time analysis was performed using the Kaplan-Meier method, and between-group differences in overall survival time (OS) were evaluated by the log-rank test.
A total of 231 NSCLC patients were divided into 57 patients with M1b and 174 with M1c. Median OS was 15.2 months (95% confidence interval [CI]: 9.3-19.9) and 7.3 months (95% CI 5.7-10.7) for M1b and M1c, respectively, with no significant between-group difference (P = 0.239). However, after excluding patients with epidermal growth factor receptor (EGFR) mutation or echinoderm microtubule-associated protein-like 4 and anaplastic lymphoma kinase (EML4-ALK) fusion gene, median OS was 12.9 months (95% CI 7.2-19.9) for M1b and 5.4 months (95% CI 3.8-6.3) for M1c, respectively, showing a significant difference (P = 0.029).
The effect of therapy directed toward EGFR mutation or EML4-ALK fusion gene might obscure the significant prognostic difference between M1b and M1c.
在第八版肺癌 TNM 分期中，M1b 和 M1c 描述符是通过胸外转移的数量新定义的。为了验证这些描述符在日本的预后价值，我们重新分类了病例并重新评估了 M1b 和 M1c 患者的预后。
评估了 2010 年至 2016 年期间在埼玉医疗中心就诊的所有患有胸外转移的非小细胞肺癌（NSCLC）患者，根据第八版 TNM 分类标准将患者分为两组（M1b，单发胸外转移患者；M1c，多发胸外转移患者），并随访至 2017 年 12 月 31 日。采用 Kaplan-Meier 法进行生存时间分析，对数秩检验评估总生存时间（OS）的组间差异。
共纳入 231 例 NSCLC 患者，其中 57 例患者为 M1b，174 例患者为 M1c。M1b 和 M1c 的中位 OS 分别为 15.2 个月（95%CI：9.3-19.9）和 7.3 个月（95%CI 5.7-10.7），两组之间无显著差异（P=0.239）。然而，排除表皮生长因子受体（EGFR）突变或棘皮动物微管相关蛋白样 4 和间变性淋巴瘤激酶（EML4-ALK）融合基因患者后，M1b 的中位 OS 为 12.9 个月（95%CI 7.2-19.9），M1c 为 5.4 个月（95%CI 3.8-6.3），两组之间有显著差异（P=0.029）。
针对 EGFR 突变或 EML4-ALK 融合基因的治疗效果可能掩盖了 M1b 和 M1c 之间显著的预后差异。
