Robold Tobias, Neumeier Jakob, Ried Michael, Neu Reiner, Sziklavari Zsolt, Grosser Christian, Klinkhammer-Schalke Monika, Hofmann Hans-Stefan
Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland.
Klinik für Thoraxchirurgie, regioMed-Kliniken GmbH, Coburg, Deutschland.
Zentralbl Chir. 2020 Dec;145(6):589-596. doi: 10.1055/a-1164-7058. Epub 2020 Jul 6.
The 8th edition of the TNM classification combined with the latest update of the S3-guideline (by AWMF/Scientific Medical Societies in Germany) on prevention, diagnosis, therapy and follow-up of lung cancer led to several changes in staging and treatment of lung cancer. The aim of this study was to identify differences in the distribution of patients due to changes from the 7th to the 8th edition that affected staging. The influence on surgical therapy will be discussed by using the recommendations of the latest S3 guideline.
Prospective analysis of all primary cases at two thoracic surgical centres in the year 2016 and follow-up in March 2019. Comparison of the 7th edition of tumour classification for lung cancer with the 8th edition, focused on changes in tumour staging and its effects on the appropriate surgical therapy according to the latest S3 guideline.
A total of 432 primary cases comprised the study population. According to the 8th edition, 82 patients (7th edition: n = 85) in stage I, 43 (n = 49) patients in stage II, 100 (n = 91) patients in stage III and 207 (n = 207) patients are assigned to stage IV. 81 changes (18.7%) were detected (77 upgrades vs. 4 downgrades). 63 patients (14.6%) exhibited a different graduation within the stages. 18 patients (4.1%) were classified in different tumour stages. As a result, fewer patients (n = 12; 2.8%) should have surgery according to the latest S3 guidelines. 290 patients (67.1%) were classified to new subgroups (IA1-3, IIIC and IVA/B). Two-year survival was significantly higher in IVA (25.2%) vs. IVB (13.0%) patients (p < 0.05).
The 8th edition of the TNM-classification affords a higher level of differentiation. In this study, the new TNM classification led to a shift in the distribution, with a tendency to increase the tumour stage. This is mainly caused by changes in the T-descriptor and stage grouping. As a result, fewer patients in stage I - IIIA should have surgery according to the latest S3 guidelines. A significantly higher two-year survival rate was detected in stage IVA (M1a and M1b) compared to IVB and justifies the new differentiation due to the metastatic pattern.
第8版TNM分期系统，结合德国医学科学协会（AWMF）发布的S3肺癌防治指南最新更新版，导致肺癌分期和治疗发生了多项变化。本研究旨在确定第7版到第8版分期变化对患者分布的影响。同时，将依据最新S3指南的建议，探讨这些变化对手术治疗的影响。
对2016年两个胸外科中心的所有原发性肺癌病例进行前瞻性分析，并于2019年3月进行随访。将第7版肺癌肿瘤分类与第8版进行比较，重点关注肿瘤分期的变化及其对根据最新S3指南选择合适手术治疗的影响。
本研究共纳入432例原发性肺癌病例。依据第8版TNM分期，I期患者82例（第7版：85例），II期患者43例（第7版：49例），III期患者100例（第7版：91例），IV期患者207例（第7版：207例）。共检测到81处分期变化（18.7%），其中77例分期上调，4例分期下调。63例患者（14.6%）在各期内分级不同，18例患者（4.1%）被分到不同肿瘤分期。结果显示，根据最新S3指南，应接受手术的患者减少（12例，2.8%）。290例患者（67.1%）被分到新的亚组（IA1 - 3、IIIC和IVA/B）。IVA期患者（25.2%）的两年生存率显著高于IVB期患者（13.0%）（p < 0.05）。
第8版TNM分期系统具有更高的区分度。本研究中，新的TNM分期导致患者分布发生变化，肿瘤分期有上升趋势。这主要是由于T描述符和分期分组的改变。因此，根据最新S3指南，I - IIIA期应接受手术的患者减少。与IVB期相比，IVA期（M1a和M1b）患者两年生存率显著更高，这也证明了基于转移模式进行新分期的合理性。
