应用第八版肺癌TNM分期进行病理分期的研究和探讨  

Clinical application of the TNM classification for lung cancer (eighth edition) in pathologic staging

作　　者：于佳琪 孙平丽[1] 贾梦 曹岚清 高洪文[1] YU Jia-qi;SUN Ping-li;JIA Meng;CAO Lan-qing;GAO Hong-wen(Department of Pathology,the Second Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第二医院病理科

出　　处：《诊断病理学杂志》2019年第10期655-659,663,共6页Chinese Journal of Diagnostic Pathology

基　　金：吉林省科技厅基础处项目,吉林省肿瘤分子病理诊断重点实验室(20170622006JC);吉林省科技厅基础处项目,上皮-间质转化在ROS1阳性肺癌靶向治疗耐药中的作用和分子机制研究(20180101014JC);吉林省省直厅局项目,Hippo信号通路调控上皮间质转化对肺癌进展和耐药的研究(3D5177723429)

摘　　要：目的探讨应用第八版TNM分期对肿瘤浸润性直径进行分期的临床意义。方法回顾性分析具有贴壁样成分的≤5 cm N0M0肺腺癌切除病例200例,按照新分期进行病理分期后的变化及临床意义。结果以浸润性直径进行分期后,有54.5%(109/200)的肿瘤发生了T分期的改变;39.5%的肿瘤发生了IA期下调改变,11%(22/200)的病例由IB期变成IA期,4%(8/200)的病例由II期变成了I期,占整个II期病例的40%(8/20)。浸润性直径大小对患者生存期具有更好的预测作用,且浸润性肿瘤大小与肺部CT实性区大小显示更好的正相关性。结论直径1~2 cm的肿瘤中,存在非浸润性成分的概率大于其他肿瘤。新分期与影像学联系更密切,兼顾了肿瘤的病理学和影像学特性,浸润性肿瘤大小对生存期的预测明显好于肿瘤总大小。Objective To investigate the clinical significance of the pathological staging of lung cancer classified by invasive size according to the eighth edition of the TNM classification for lung cancer.Methods We retrospectively analyzed 200 cases of N0 M0 lung adenocarcinoma which all included a lepidic growth component.The size of the tumors was less than or equal to 5 cm in diameter,and the tumors were classified by invasive tumor size according to the eighth edition of the TNM classification for lung cancer.Then we evaluated the changes of the pathologic stage by the new classification and its clinical significance.Results Compared to the primary T stage by total tumor size,the pathologic T stage was changed in 54.5%(109/200)of lung adenocarcinoma classified by invasive size,39.5%of the IA tumors were down staged(IA2 was changed into IA1,IA3 changed into IA1 or IA2),11%(22/200)of the IB stage changed into IA stage,and 4%(8/200)of the tumors changed from stage II into stage I,which accounted for 40%(8/20)of all the stage II tumors.Compared to the total size of the tumor,the invasive size had the better predictive effect for progression-free survival,and correlation analysis showed that the invasive size of tumor had positive correlation with the size of solid area in lung CT image.Conclusions The T1 b stage(1~2 cm in diameter)lung adenocarcinomas is more likely to have non-invasive components than other tumors.The new edition of TNM classification is more closely related to the imaging features of the tumor and takes into account of the pathological and imaging characteristics of the tumor.The prediction of survival time based on invasive tumor size is better than that of total size.

关 键 词：肺腺癌 TNM分期 浸润性肿瘤直径 预后 影像学 

分 类 号：R734.2[医药卫生—肿瘤]