国际肺癌研究协会提出的 N 描述符在临床分期中的应用。
Application of N Descriptors Proposed by the International Association for the Study of Lung Cancer in Clinical Staging.
机构信息
From the Department of Radiology (H.S., S.H.Y., Junghoon Kim, Jihang Kim, K.W.L., K.H.L.), Department of Thoracic and Cardiovascular Surgery (K.K.), Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine (C.T.L.), and Department of Pathology and Translational Medicine (J.H.C.), Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam 13620, Korea; and Departments of Public Health Science, Graduate School of Public Health (W.L.) and Applied Bioengineering, Graduate School of Convergence Science and Technology (S.L.), Seoul National University, Seoul, Korea.
出版信息
Radiology. 2021 Aug;300(2):450-457. doi: 10.1148/radiol.2021204461. Epub 2021 Jun 1.
Background Patients with N1 or N2 non-small cell lung cancer exhibit prognostic heterogeneity. To refine the current N staging system, new N stages were proposed by the International Association for the Study of Lung Cancer. However, those proposed new N stages have not been validated. Purpose To evaluate the prognostic performance of the proposed N descriptors for clinical staging. Materials and Methods Participants with non-small cell lung cancer without distant metastasis from January 2010 to December 2014 were retrospectively included. Each patient's clinical N (cN) stage was assigned to one of seven categories (cN0, cN1a, cN1b, cN2a1, cN2a2, cN2b, cN3). The 5-year overall survival rates were estimated with the Kaplan-Meier method. The adjusted hazard ratios (HRs) and their 95% CIs were estimated by using a multivariable Cox proportional hazard model. Ad hoc analyses according to lymph node (LN) size were performed. Results A total of 1271 patients (median age, 66 years; interquartile range, 59-73 years; 812 men) were included. The 5-year overall survival rates were 77.3%, 53.7%, 36.0%, 29.2%, 34.4%, 18.0%, and 12.4% for stages cN0, cN1a, cN1b, cN2a1, cN2a2, cN2b, and cN3, respectively. Patients with cN2b disease had a worse prognosis than patients with cN2a disease (HR, 1.53; 95% CI: 1.06, 2.22; = .02). There was no prognostic difference between cN1b and cN1a (HR, 1.13; 95% CI: 0.61, 2.09; = .71); however, there was a difference between cN1 subgroups when stratified by LN size (≥2 cm; HR, 2.26; 95% CI: 1.16, 4.44; = .02). Within cN2a disease, there were no differences between cN2a1 and cN2a2 (HR, 0.98; 95% CI: 0.61, 1.56; = .93) or between subgroups according to LN size (HR, 0.74; 95% CI: 0.40, 1.37; = .34). Conclusion A survival difference was observed between single- and multistation involvement among cN2 disease. The number of involved lymph node stations in patients with cN1 disease and the presence of skip metastasis in patients with cN2 disease were not associated with survival differences. © RSNA, 2021
背景
N1 或 N2 期非小细胞肺癌患者表现出预后异质性。为了完善现行的 N 分期系统，国际肺癌研究协会提出了新的 N 分期。然而，这些新提出的 N 分期尚未得到验证。
目的
评估国际肺癌研究协会提出的新 N 描述符用于临床分期的预后性能。
材料与方法
回顾性纳入 2010 年 1 月至 2014 年 12 月无远处转移的非小细胞肺癌患者。每位患者的临床 N（cN）分期被分配到以下七个类别之一（cN0、cN1a、cN1b、cN2a1、cN2a2、cN2b、cN3）。采用 Kaplan-Meier 法估计 5 年总生存率。使用多变量 Cox 比例风险模型估计调整后的危险比（HR）及其 95%置信区间。根据淋巴结（LN）大小进行了专门分析。
结果
共纳入 1271 例患者（中位年龄 66 岁；四分位间距 59-73 岁；812 例男性）。cN0、cN1a、cN1b、cN2a1、cN2a2、cN2b 和 cN3 分期患者的 5 年总生存率分别为 77.3%、53.7%、36.0%、29.2%、34.4%、18.0%和 12.4%。cN2b 疾病患者的预后较 cN2a 疾病患者差（HR，1.53；95%CI：1.06，2.22； =.02）。cN1b 和 cN1a 之间无预后差异（HR，1.13；95%CI：0.61，2.09； =.71）；然而，当按 LN 大小分层时，cN1 亚组之间存在差异（≥2 cm；HR，2.26；95%CI：1.16，4.44； =.02）。在 cN2a 疾病中，cN2a1 和 cN2a2 之间无差异（HR，0.98；95%CI：0.61，1.56； =.93），或根据 LN 大小进行分层时亚组之间无差异（HR，0.74；95%CI：0.40，1.37； =.34）。
结论
在 cN2 疾病中，单站和多站受累之间观察到生存差异。cN1 疾病中受累淋巴结站的数量和 cN2 疾病中跳跃性转移的存在与生存差异无关。
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