美国癌症联合委员会（AJCC）第8版非小细胞肺癌（NSCLC）TNM分期手册中，M1a描述符包括出现恶性胸腔或心包积液的肿瘤（“M1a-Effusion”），胸膜或心包结节（“M1a-Pleural”）或同侧叶的单独肿瘤结节（“M1a-Contralateral”）。M1a NSCLC患者中，出现恶性胸腔或心包积液是否与其他类型的M1a NSCLC相比存活率更差？纳入2010-2015年国家癌症数据库中满足AJCC第8版分期标准的cT1-4、N0-3、M1a NSCLC患者（满足单一M1a描述符“M1a-Effusion”、“M1a-Pleural”或“M1a-Contralateral”）进行分析。使用Kaplan-Meier分析、多变量调整的Cox比例风险建模和倾向评分匹配评估总体生存率。符合研究入选标准的25,716名患者中，12,756名（49.6%）患有M1a-Effusion肿瘤，3,589名（14.0%）患有M1a-Pleural肿瘤，9,371名（36.4%）患有M1a-Contralateral肿瘤。根据多变量调整分析，M1a-Effusion肿瘤与M1a-Pleural肿瘤（HR：1.48，95% CI：1.40-1.56，p<0.001）和M1a-Contralateral肿瘤（HR：1.51，95% CI：1.46-1.57，p<0.001）相比，与更差的总体生存率相关。M1a-Pleural肿瘤和M1a-Contralateral肿瘤之间的总体生存率差异不显著（HR：0.98，95% CI：0.93-1.03，p=0.42）。对5,581名患有M1a-Effusion肿瘤和5,581名患有其他M1a肿瘤（即M1a-Contralateral或M1a-Effusion）的患者进行倾向评分匹配分析后发现，M1a-Effusion肿瘤的5年总体生存率较其他M1a肿瘤更差（M1a-Effusion：6.4% [95% CI：5.7-7.1] vs M1a-Other：10.6% [95% CI：9.7-11.5]，p<0.001）。在这项对AJCC第8版cT1-4、N0-3、M1a NSCLC进行的全国分析中，具有恶性胸腔或心包积液的肿瘤的总体生存率低于具有胸膜或同侧肺结节的肿瘤。这些发现可以在即将出版的第9版肺癌分期指南中予以考虑。 版权所有 © 2023. Elsevier Inc. 发表

The American Joint Committee on Cancer (AJCC) 8th Edition TNM staging manual for non-small-cell lung cancer (NSCLC) M1a descriptors include tumors presenting with malignant pleural or pericardial effusion ("M1a-Effusion"), pleural or pericardial nodule(s) ("M1a-Pleural"), or separate tumor nodule(s) in a contralateral lobe ("M1a-Contralateral").Is M1a NSCLC presenting with malignant pleural or pericardial effusion associated with worse survival compared to other types of M1a NSCLC?Patients with cT1-4, N0-3, M1a NSCLC (satisfying a single M1a descriptor of "M1a-Effusion", "M1a-Pleural", or "M1a-Contralateral"), according to AJCC 8th edition staging criteria, in the National Cancer Database from 2010-2015 were included. Overall survival was evaluated using Kaplan-Meier analysis, multivariable-adjusted Cox proportional hazards modeling, and propensity score matching.Of the 25,716 patients who met study eligibility criteria, 12,756 (49.6%) had M1a-Effusion tumors, 3,589 (14.0%) had M1a-Pleural tumors, and 9,371 (36.4%) had M1a-Contralateral tumors. In multivariable-adjusted analysis, M1a-Effusion tumors were associated with worse overall survival than M1a-Pleural (HR: 1.48, 95% CI: 1.40-1.56, p<0.001) and M1a-Contralateral tumors (HR: 1.51, 95% CI: 1.46-1.57, p<0.001). No significant differences were found in overall survival between M1a-Pleural and M1a-Contralateral tumors (HR: 0.98, 95% CI: 0.93-1.03, p=0.42). In a propensity score-matched analysis of 5,581 patients with M1a-Effusion tumors and 5,581 patients with other M1a tumors (i.e., M1a-Contralateral or M1a-Effusion), M1a-Effusion tumors had worse 5-year overall survival than other M1a tumors (M1a-Effusion: 6.4% [95% CI: 5.7-7.1] vs M1a-Other: 10.6% [95% CI: 9.7-11.5], p<0.001).In this national analysis of AJCC 8th Edition cT1-4, N0-3, M1a NSCLC, tumors with malignant pleural or pericardial effusion had worse overall survival than tumors with either pleural or contralateral pulmonary nodules. These findings may be taken into consideration for the upcoming 9th edition lung cancer staging guidelines.Copyright © 2023. Published by Elsevier Inc.