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作者：CardiothoracicSurgery
*仅供医学专业人士参考
第8版TNM分型中关于临床T分期的问题:部分实体瘤中实体成分直径难以测量的小肺癌的预后和EGFR突变状况
AATS 2023
原文标题
A Problem with Clinical T Factor In The 8th TNM Edition: Prognosis and EGFR Mutation Status of Small Sized Lung Cancers with Difficulty to Measure the Diameter Of Solid Component In Part-Solid Tumor
作者及单位
Haiquan Chen , Invited Discussant , Fudan University Shanghai Cancer Center
Takeshi Matsunaga , Abstract Presenter , Juntendo University School of Medicine
背景
肺癌TNM 第8版分型中临床T分期存在一个现实问题。我们有时会遇到难以测量部分实体肿瘤中实体成分大小的病例，如何对这些肿瘤进行分类是有争议的。
方法
我们根据2009年至2012年第7版TNM肺癌分类评估了590例手术切除的cT1N0M0期IA。在薄层CT上测量肿瘤直径和实体成分直径。我们将难以测量实体成分大小的肿瘤定义为分散实变肺癌(LCSCs) 。其中79例患者(13.4%)观察到LCSCs。其他肿瘤根据第8版分类为cTis、cT1mi、cT1a、cT1b、cT1c。cTis 99例，cT1mi 52例，cT1a 68例，cT1b 166例，cT1c 126例。我们比较这些肿瘤的预后。此外，我们比较了LCSCs与cT1a、cT1b和cT1c的预后和表皮生长因子受体突变(EGFRm)状态，以探讨LCSCs属于哪一类。
结果
中位随访时间为85.5个月。LCSCs、cTis、cT1mi、cT1a、cT1b和cT1c的5年总生存率(OS)分别为92.4%、99.0%、92.2%、96.9%、76.8%和65.0%。cT1a、cT1b和cT1c预后差异显著(cT1a vs cT1b (5yOS: 96.9% vs 76.8%);p值<0.001,cT1b vs cT1c(5岁:76.8% vs 65.0%);假定值= 0.035)。LCSCs的预后明显优于cT1b (5yOS: 92.4% vs 76.8, p值=0.002)，LCSCs与cT1a之间无显著差异(5yOS: 92.4% vs 96.9%， p值=0.169)。cT1a、cT1b和cT1c患者EGFRm发生频率差异有统计学意义(52.4%、42.4%和29.8%，p值=0.010)。EGFRm在LCSCs中的发生率为54.8% (40/73)，LCSCs与cT1a之间无显著差异(p值=0.778)。
结论
LCSCs预后良好，与cT1a预后相当。此外，LCSCs和cT1a之间的EGFRm状态相似。因此，由于我们无法在小型肺癌中测量实体成分的直径作为临床T因素，因此将这些肿瘤分类为cT1a可能是合适的。
作者简介
Haiquan Chen
Invited Discussant
Dr. Chen is the chairman and a professor in the Department of Thoracic Surgery at the Fudan University Shanghai Cancer Center, where he is also the director of the Institute of Thoracic Oncology and the Lung Cancer Center.
He is the vice chief editor of the Journal of Cancer Research and Clinical Oncology and an editorial board member of various other publications, including the Journal of Thoracic and Cardiovascular Surgery. Dr. Chen is the principal investigator of over 10 programs, including two key programs of the National Natural Science Foundation of China. He has authored more than 210 SCI papers in academic journals, including Cancer Cell, JCO and CCR. Innovative findings in 17 of his papers have been cited in 11 international guidelines of lung cancer such as ASCO, ESMO, ACCP and IASLC.
Takeshi Matsunaga
Abstract Presenter
Associate Professor, MD., PhD
Department of General Thoracic Surgery, Juntendo University School of Medicine
1-3, Hongo 3-chome, Bunkyo-ku, Tokyo
113-8431, Japan
Tel: +81-3-3813-3111 Fax: +81-3-5800-0281
E-mail: matsu812@juntendo.ac.jp
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