Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, P. R. China.
Department of Thoracic Surgery, Huadong Hospital Affiliated to Fudan University, Shanghai, P. R. China.
Eur J Cardiothorac Surg. 2024 Mar 1;65(3). doi: 10.1093/ejcts/ezae071.
The 9th edition of tumour-node-metastasis (TNM) staging for lung cancer was announced by Prof Hisao Asamura at the 2023 World Conference on Lung Cancer in Singapore. The purpose of this study was to externally validate and compare the latest staging of lung cancer.
We collected 19 193 patients with stage IA-IIIA non-small cell lung cancer (NSCLC) who underwent lobectomy from the Surveillance, Epidemiology and End Results database. Survival analysis by TNM stages was compared using the Kaplan-Meier method and further analysed using univariable and multivariable Cox regression analyses. Receiver operating characteristic curves were used to assess model accuracy, Akaike information criterion, Bayesian information criterion and consistency index were used to compare the prognostic, predictive ability between the current 8th and 9th edition TNM classification.
The 9th edition of the TNM staging system can better distinguish between IB and IIA patients on the survival curve (P < 0.0001). In both univariable and multivariable regression analysis, the 9th edition of the TNM staging system can differentiate any 2 adjacent staging patients more evenly than the 8th edition. The 9th and the 8th edition TNM staging have similar predictive power and accuracy for the overall survival of patients with NSCLC [TNM 9th vs 8th, area under the curve: 62.4 vs 62.3; Akaike information criterion: 166 182.1 vs 166 131.6; Bayesian information criterion: 166 324.3 vs 166 273.8 and consistency index: 0.650 (0.003) vs 0.651(0.003)].
Our external validation demonstrates that the 9th edition of TNM staging for NSCLC is reasonable and valid. The 9th edition of TNM staging for NSCLC has near-identical prognostic accuracy to the 8th edition.
第 9 版肺癌肿瘤-淋巴结-转移（TNM）分期由 Hisao Asamura 教授在新加坡举行的 2023 年世界肺癌大会上公布。本研究的目的是对外验证和比较最新的肺癌分期。
我们从监测、流行病学和最终结果数据库中收集了 19193 例接受肺叶切除术的 IA-IIIA 期非小细胞肺癌（NSCLC）患者。通过 Kaplan-Meier 方法比较 TNM 分期的生存分析，并进一步通过单变量和多变量 Cox 回归分析进行分析。接收者操作特征曲线用于评估模型准确性，Akaike 信息准则、贝叶斯信息准则和一致性指数用于比较当前第 8 版和第 9 版 TNM 分类的预后和预测能力。
第 9 版 TNM 分期系统在生存曲线上能更好地区分 IB 期和 IIA 期患者（P<0.0001）。在单变量和多变量回归分析中，第 9 版 TNM 分期系统能更均匀地区分任何 2 个相邻的分期患者。第 9 版和第 8 版 TNM 分期对 NSCLC 患者的总生存具有相似的预测能力和准确性[TNM 9th 与 8th，曲线下面积：62.4 与 62.3；Akaike 信息准则：166182.1 与 166131.6；贝叶斯信息准则：166324.3 与 166273.8 和一致性指数：0.650（0.003）与 0.651（0.003）]。
我们的外部验证表明，第 9 版 NSCLC 的 TNM 分期是合理和有效的。第 9 版 NSCLC 的 TNM 分期与第 8 版具有几乎相同的预后准确性。
