基于中国胸腺瘤协作组回顾性数据库对比Masaoka-Koga分期和国际肺癌协会/国际胸腺肿瘤协作组提出的TNM分期系统  

Comparison of the Masaoka-Koga and The IASLC/ITMIG Proposal for The TNM Staging Systems Based on the Chinese Alliance for Research in Thymomas(ChART) Retrospective Database

作　　者：梁光辉 谷志涛[2] 李印 傅剑华[3] 沈毅[4] 魏煜程 谭黎杰[5] 张鹏[6] 韩泳涛[7] 陈椿[8] 张仁泉[9] 陈克能[10] 陈和忠[11] 刘永煜 崔有斌[13] 王允[14] 庞烈文[15] 于振涛[16] 周鑫明[17] 柳阳春[18] 刘媛[2] 方文涛[2] 中国胸腺肿瘤协作组成员 

机构地区：[1]郑州大学附属肿瘤医院胸外科,郑州200032 [2]上海交通大学附属上海胸科医院,上海200030 [3]中山大学附属肿瘤医院胸外科,广州510060 [4]青岛大学医学院附属医院胸外科,青岛266001 [5]复旦大学附属中山医院胸外科,上海200032 [6]天津医科大学附属总医院胸外科,天津300052 [7]四川省肿瘤医院胸外科,成都610041 [8]福建医科大学附属协和医院胸外科,福州350001 [9]安徽医科大学附属第一医院胸外科,合肥230022 [10]北京大学附属肿瘤医院胸外科,北京100142 [11]长海医院胸心外科,上海200433 [12]辽宁肿瘤医院胸外科,沈阳110042 [13]吉林大学附属第一医院胸外科,长春130021 [14]四川大学华西医院胸外科,成都610041 [15]复旦大学附属华山医院胸外科,上海200032 [16]天津医科大学附属肿瘤医院食管癌中心,天津300060 [17]浙江省肿瘤医院胸外科,杭州310022 [18]江西省人民医院胸外科,南昌330006

出　　处：《中国肺癌杂志》2016年第7期425-436,共12页Chinese Journal of Lung Cancer

摘　　要：背景与目的使用中国胸腺协作组(Chinese Alliance for Research in Thymomas,ChART)回顾性数据,比较Masaoka-Koga分期系统和国际肺癌协会(International Association for the Study of Lung Cancer,IASLC)/国际胸腺肿瘤协作组(International Thymic Malignancies Interest Group,ITMIG)推荐的新TNM分期对胸腺肿瘤预后的预测作用。方法我们回顾分析了1992年-2012年ChART数据库共2,370例患者。其中1,198例信息完整的患者被纳入研究,按照TNM及Masaoka-Koga分期系统进行分期,并进行生存分析。评估指标为R0患者的累积复发率(cumulative incidence of recurrence,CIR)以及患者总生存率(overall survival,OS)。对比分析MasaokaKoga分期系统和新的TNM分期系统。结果根据Masaoka-Koga分期系统,不同分期CIR差异具有统计学意义,其中Ⅰ期和Ⅱ期或者Ⅱ期和Ⅲ期之间累积复发率无差异,Ⅳ期的患者具有更高的复发率,预后最差。根据新的TNM分期系统,T1a患者的累积复发率低于其他患者(P<0.05),T1a患者总生存高于T1b患者(P=0.004),T4患者总生存率差于其它患者。N(+)患者累及复发率及总生存率差于N0患者。在M0患者与M1b患者之间总体累积复发率和总体生存率差异具有统计学意义,但在M0和M1b患者之间二者无差异。Ⅰ期-IIIa期与IIIb期-IVb期患者之间总生存率具有差异,然而IIIb期与IVb期患者之间总生存率无差异。结论与Masaoka-Koga分期相比,IASLC/ITMIG TNM分期系统不仅描述了肿瘤侵犯的范围,也提供了有关淋巴结转移和肿瘤播散的情况。使用新的TNM分期系统进行前瞻性研究有助于更好的对胸腺肿瘤分组,预测预后,并指导治疗。Background and objectiveTo compare the predictive effect of the Masaoka-Koga staging system and the International Association for the Study of Lung Cancer （IASLC）/the International Thymic Malignancies Interest Group （ITMIG） proposal for the new TNM staging on prognosis of thymic malignancies using the Chinese Alliance for Research in Thymomas （ChART） retrospective database.MethodsFrom 1992 to 2012, 2,370 patients in ChART database were ret-rospectively reviewed. Of these, 1,198 patients with complete information on TNM stage, Masaoka-Koga stage, and survival were used for analysis. Cumulative incidence of recurrence （CIR） was assessed in R0 patients. Overall survival （OS） was evalu-ated both in an R0 resected cohort, as well as in all patients （any R status）. CIR and OS were ifrst analyzed according to the Masaoka-Koga staging system. Then, they were compared using the new TNM staging proposal.Results Based on Masaoka-Koga staging system, signiifcant difference was detected in CIR among all stages. However, No survival difference was revealed between stage I and II, or between stage II and III. Stage IV carried the highest risk of recurrence and worst survival. According to the new TNM staging proposal, CIR in T1a was signiifcantly lower comparing to all other T categories （P〈0.05） and there is a signiifcant difference in OS between T1a and T1b （P=0.004）. T4 had the worst OS comparing to all other T categories. CIR and OS were signiifcantly worse in N（＋） than in N0 patients. Signiifcant difference in CIR and OS was detected between M0 and M1b, but not between M0 and M1a. OS was almost always statistically different when comparison was made between stages I-IIIa and stages IIIb-IVb. However, no statistical difference could be detected among stages IIIb to IVb.Conclusion Compared with Masaoka-Koga staging, the IASLC/ITMIG TNM staging proposal not only describes the extent of tumor invasion but also provides information on lymphatic involvement and tumor dissemination. Further

关 键 词：胸腺瘤 分期 预后分组 

分 类 号：R736.3[医药卫生—肿瘤]