【摘要翻译】局限性肾细胞癌应用2002年版TNM分期：能否预测出肿瘤特异生存情况的差异？
发布于 2004-06-17 · 浏览 977 · IP 陕西陕西
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[文题]Application of TNM, 2002 version, in localized renal cell carcinoma: is it able to predict different cancer-specific survival probability?
局限性肾细胞癌应用2002年版TNM分期：能否预测出肿瘤特异生存情况的差异？
[来源]Urology
[年、卷、期、页]2004. 63（6）：1050-1054
[作者]Vincenzo Ficarra, Giacomo Novara, Antonio Galfano, Giovanni Novella, Dionisio Schiavone and Walter Artibani
[原文摘要]
Objectives
To verify whether the latest version of the TNM staging system (2002) could predict different cancer-specific survival in patients with localized renal cell carcinoma (RCC; Stage T1-T2N0M0).
Methods
According to the 2002 TNM staging system, we reassigned the pathologic stage of 702 patients who had undergone surgical treatment for RCC from 1976 to 2000. We selected 491 patients with localized RCC (pT1-T2N0M0). In 334 patients (68.0%), we had performed radical nephrectomy; in 121 (24.6%), elective nephron-sparing surgery; and in 36 (7.3%), imperative nephron-sparing surgery. Cancer-specific survival was estimated according to the Kaplan-Meier method. The log-rank test and Cox's proportional hazard model was used for univariate and multivariate analysis, respectively.
Results
Of the 491 tumors, 249 (50.7%) were classified as pT1a, 155 (31.6%) as pT1b, and 87 (17.7%) as pT2. The median follow-up was 75 months. The 5-year and 10-year cancer-specific survival probabilities were, respectively, 97.4% and 95.6% in the pT1a patients, 92.5% and 89.8% in the pT1b patients, and 89.3% and 78.5% in the pT2 patients. The survival curve comparison was statistically significant both between pT1a and pT1b (log-rank test, P = 0.01) and between pT1a and pT2 (log-rank test, P = 0.0007). No statistically significant difference was observed between the pT1b and pT2-specific survival probabilities (log-rank test, P = 0.42).
Conclusions
The 2002 TNM staging system does not seem able to predict different cancer-specific survival between pT1b and pT2 RCC. These data highlight the need to define an optimal breakpoint to stratify patients with localized RCC.
[中文译文]
目的：验证最新的TNM分期系统（2002）对局限性肾细胞癌（RCC；分期T1-T2N0M0）患者能否预测出肿瘤特异生存情况的差异。
方法：按照2002年的TNM分期系统，我们重新登记了702例患者的病理分期情况，患者为1976-2000年间行手术治疗的RCC患者。从中选择了491例局限性RCC（pT1-T2N0M0）。其中334例（68.0%）行根治性肾切除术；121例（24.6%）行选择性保留肾单位手术；36例（7.3%）行被迫的保留肾单位手术。肿瘤特异生存情况评估采用Kaplan-Meier方法。单参数和多元分析分别应用log-rank检验和Cox比例风险回归模型。
结果：491例肿瘤中，249例（50.7%）为pT1a期，155例（31.6%）为pT1b期，87例（17.7%）为pT2期。中位随访75个月。pT1a患者的5年和10年肿瘤特异生存概率分别为97.4%和95.6%；pT1b期患者为92.5%和89.8%；pT2期患者为89.3%和78.5%。pT1a期和pT1b期两组间生存曲线比较有显著差异（log-rank检验，p=0.01），pT1a期和pT2期两组间亦有显著差异（log-rank检验，p=0.0007）。但pT1b期和pT2期两组间特异生存概率无显著差异（log-rank检验，p=0.42）。
结论：2002年的TNM分期系统看来不能预测pT1b和pT2期RCC间的肿瘤特异生存情况的差异。本数据着重提出对于局限性肾癌患者需要定义一个更优的分期点。
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[个人评论]本文是一个回顾性的研究，从摘要看，并没有剔除手术方案对生存情况的影响，不同手术方法对特异生存情况必然有影响，因此单纯比较肿瘤不同分期间的特异生存概率无显著差异就据此否定分期不那么令人信服。
附：2002年TNM分期系统
局限性肾细胞癌应用2002年版TNM分期：能否预测出肿瘤特异生存情况的差异？
[来源]Urology
[年、卷、期、页]2004. 63（6）：1050-1054
[作者]Vincenzo Ficarra, Giacomo Novara, Antonio Galfano, Giovanni Novella, Dionisio Schiavone and Walter Artibani
[原文摘要]
Objectives
To verify whether the latest version of the TNM staging system (2002) could predict different cancer-specific survival in patients with localized renal cell carcinoma (RCC; Stage T1-T2N0M0).
Methods
According to the 2002 TNM staging system, we reassigned the pathologic stage of 702 patients who had undergone surgical treatment for RCC from 1976 to 2000. We selected 491 patients with localized RCC (pT1-T2N0M0). In 334 patients (68.0%), we had performed radical nephrectomy; in 121 (24.6%), elective nephron-sparing surgery; and in 36 (7.3%), imperative nephron-sparing surgery. Cancer-specific survival was estimated according to the Kaplan-Meier method. The log-rank test and Cox's proportional hazard model was used for univariate and multivariate analysis, respectively.
Results
Of the 491 tumors, 249 (50.7%) were classified as pT1a, 155 (31.6%) as pT1b, and 87 (17.7%) as pT2. The median follow-up was 75 months. The 5-year and 10-year cancer-specific survival probabilities were, respectively, 97.4% and 95.6% in the pT1a patients, 92.5% and 89.8% in the pT1b patients, and 89.3% and 78.5% in the pT2 patients. The survival curve comparison was statistically significant both between pT1a and pT1b (log-rank test, P = 0.01) and between pT1a and pT2 (log-rank test, P = 0.0007). No statistically significant difference was observed between the pT1b and pT2-specific survival probabilities (log-rank test, P = 0.42).
Conclusions
The 2002 TNM staging system does not seem able to predict different cancer-specific survival between pT1b and pT2 RCC. These data highlight the need to define an optimal breakpoint to stratify patients with localized RCC.
[中文译文]
目的：验证最新的TNM分期系统（2002）对局限性肾细胞癌（RCC；分期T1-T2N0M0）患者能否预测出肿瘤特异生存情况的差异。
方法：按照2002年的TNM分期系统，我们重新登记了702例患者的病理分期情况，患者为1976-2000年间行手术治疗的RCC患者。从中选择了491例局限性RCC（pT1-T2N0M0）。其中334例（68.0%）行根治性肾切除术；121例（24.6%）行选择性保留肾单位手术；36例（7.3%）行被迫的保留肾单位手术。肿瘤特异生存情况评估采用Kaplan-Meier方法。单参数和多元分析分别应用log-rank检验和Cox比例风险回归模型。
结果：491例肿瘤中，249例（50.7%）为pT1a期，155例（31.6%）为pT1b期，87例（17.7%）为pT2期。中位随访75个月。pT1a患者的5年和10年肿瘤特异生存概率分别为97.4%和95.6%；pT1b期患者为92.5%和89.8%；pT2期患者为89.3%和78.5%。pT1a期和pT1b期两组间生存曲线比较有显著差异（log-rank检验，p=0.01），pT1a期和pT2期两组间亦有显著差异（log-rank检验，p=0.0007）。但pT1b期和pT2期两组间特异生存概率无显著差异（log-rank检验，p=0.42）。
结论：2002年的TNM分期系统看来不能预测pT1b和pT2期RCC间的肿瘤特异生存情况的差异。本数据着重提出对于局限性肾癌患者需要定义一个更优的分期点。
---------------------------
[个人评论]本文是一个回顾性的研究，从摘要看，并没有剔除手术方案对生存情况的影响，不同手术方法对特异生存情况必然有影响，因此单纯比较肿瘤不同分期间的特异生存概率无显著差异就据此否定分期不那么令人信服。
附：2002年TNM分期系统
最后编辑于 2004-06-20 · 浏览 977
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