第八版TNM分类中的临床T因子问题：难以测量部分实性肿瘤中固体成分直径的小型肺癌的预后和EGFR突变状态。
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.
发表日期：2023 Aug 22
作者：
Takeshi Matsunaga, Kenji Suzuki, Aritoshi Hattori, Mariko Fukui, Takuo Hayashi, Kazuya Takamochi
来源：
Lung cancer (Amsterdam, Netherlands)
摘要：
第八版TNM肺癌分类中的临床T因素存在一个实际问题。在一些情况下，测量部分实质性肿瘤中固体成分的大小是困难的，对这些肿瘤的分类存在争议。我们根据2009年至2012年的第七版评估了590例切除的cT1N0M0期IA非小细胞肺癌。使用薄层CT测量了肿瘤和固体成分的直径。我们将难以测量固体成分大小的肿瘤定义为散在或混合浸润的肺癌（LCSMC）。79例（13.4%）患者中观察到了LCSMC。其他肿瘤根据第八版被分类为cTis、cT1mi、cT1a、cT1b和cT1c。我们比较了LCSMC与cT1a、cT1b和cT1c的预后和表皮生长因子受体突变（EGFRm）的状态。cT1a、cT1b和cT1c之间的总生存差异是显著的（5年总生存率为96.9%对76.8%对65.0%）。在LCSMC和cT1a之间的预后没有显著差异（5年总生存率为92.4%对96.9%）。cT1a、cT1b和cT1c的EGFRm频率有显著差异（分别为52.4%、42.4%和29.8%）。LCSMC中的EGFRm发生率为54.8%，与cT1a之间没有显著差异。LCSMC的预后和EGFRm频率与cT1a非常接近。由于我们无法测量亚实质肺癌中固体成分的直径，将这些肿瘤分类为cT1a肿瘤可能是适当的。版权所有© 2023 Elsevier B.V. 保留所有权利。
Clinical T factors in the 8th TNM classification of lung cancer have a practical problem. In some cases, it is difficult to measure the size of the solid components in part-solid tumors, and the classification of these tumors is controversial.We evaluated 590 resected cT1N0M0 stage IA non-small-cell lung cancers based on the 7th edition between 2009 and 2012. Tumor and solid component diameters were measured using thin-section computed tomography (CT). We defined tumors with difficulty in measuring the size of the solid components as lung cancers with scattered or mixed consolidation (LCSMCs). LCSMCs were observed in 79 (13.4%) patients. Other tumors were classified as cTis, cT1mi, cT1a, cT1b, and cT1c, according to the 8th edition. We compared prognosis and epidermal growth factor receptor mutations (EGFRm) status of LCSMCs with those of cT1a, cT1b, and cT1c.The difference in overall survival (OS) among cT1a, cT1b, and cT1c was significant (5-year-OS: 96.9% vs. 76.8% vs. 65.0%). There was no significant difference in prognosis between LCSCs and cT1a (5-year-OS: 92.4% vs. 96.9%). A significant difference was observed in the frequency of EGFRm between cT1a, cT1b, and cT1c (52.4%, 42.4%, and 29.8%). The incidence of EGFRm in LCSMCs was 54.8% and there was no significant difference between LCSMCs and cT1a.The prognosis and frequency of EGFRm in LCSMCs were close to those in cT1a. As we cannot measure the diameter of the solid component in subsolid lung cancers, it may be appropriate to classify these tumors as cT1a tumors.Copyright © 2023 Elsevier B.V. All rights reserved.