肺癌TNM新分期方案的解读PPT课件.ppt

InterpretationofTNMNewStagingSchemeforLungCancer YongfengYuShanghaiChestHospitalAffiliatedtoShanghaiJiaotongUniversity 1 2019 11 26 1996 idea 1998 committee 1990 2000 databases 2001 finances CRAB 2002 dataset 2002 2005 dataregistry 2006 2009 publications 2010 7thedition 2009 newdataset 2009 2013 registryofnewcases 1999 2010 2013 2014 dataanalyses 2015 2016 publications 2017 8thedition 7thedition 8thedition Timelines 2 2019 12 19 Studypopulation China Japan andSouthKoreacontributedmostofthedatabase 10 294 79 clinicalstage 23838 79 pathologicalstagepathologicaltypedistribution adenocarcinomawasthemostcommontype andbothofclinicalandpathologicalstagingwas64 squamouscellcarcinoma25 and27 1999 2010lungcancerpatientssubmittedtoCRABN 94708 includedinanalysisN 77156 SCLCN 6189 NSCLCN 70967 N 33115M0completeclinical pathologicalTstaging detailedTstaginginformation N 13012completeclinicalTstaging 12449casesoperated 10084 81 0 cN0 907 7 3 cN1 1327 10 7 cN2 131 1 1 cN3 N 30018pathologicalTstagingcompletepTNM0information exceptforinductiontherapy 22257 74 2 pN0 3465 11 5 pN1 4157 13 9 pN2 139 0 5 pN3 completeresectionN 28150 94 3 2019 12 19 Catalog Tstagingadjustment tumorsize involvingthemainbronchus atelectasis pneumonia involvingdiaphragmandmediastinalpleura Otherfactors visceralpleuralinvolvement tumornodulesindifferentlobesofipsilaterallung Deficienciesandissuesneedtobefurtherstudied 4 2019 12 19 Catalog Tstagingadjustment tumorsize involvingthemainbronchus atelectasis pneumonia involvingdiaphragmandmediastinalpleura Otherfactors visceralpleuralinvolvement tumornodulesindifferentlobesofipsilaterallung Deficienciesandissuesneedtobefurtherstudied 5 2019 12 19 Tstagingadjustment tumorsize 7thedition Proposal T1a 2cm T1b 2cm but 3cm T2a 3cm but 5cm T2b 5cm but 7cm T3 7cm T1a 1cm T1b 1cm but 2cm T1c 2cm but 3cm T2a 3cm but 4cm T2b 4cm but 5cm T3 5cm but 7cm T4 7cm Newcutpoints1cm upstage upstage upstage Newcutpoints4cm 6 2019 12 19 Tumorsize mostprominentfactors 3cmisstillthepointofT1andT2 Survivalanalysiswith1cmasasegmentationpoint tumorsizeincreasingby1cm theprognosisevenworse whetherpathologicalpT1 2N0M0 R0resectionpatientsorclinicaldiagnosiscT1 2N0M0 7 2019 12 19 Tumorsize mostprominentfactors Nocrossandoverlapinsurvivalcurves statisticallysignificantdifference ThedifferencebetweenT3andT4 whichinthecurrentTNMclassificationdidnotreachstatisticaldifferences 8 2019 12 19 Tstagingadjustment involvingthemainbronchus 7thedition Proposal Distancefromcarina T2 2cm Distancefromcarina T2Nomatterhowfarfromthecarinabutnotinvolvingcarina T3 2cm 9 2019 12 19 Comparingdistancefromcarinagreaterthan2cmwithotherprognosticfactorsofT2 therewasnosignificantdifferenceinsurvival Involvingthemainbronchus 10 2019 12 19 Thedistancefromcarina 2cmbutnotinvolvingcarina currentlyT3 betterprognosisthanotherfactorsT3 Involvingthemainbronchus 11 2019 12 19 Tstagingadjustment atelectasis pneumonia 7thedition Proposal T2atelectasis pneumonianotinvolvingwholelung T2atelectasis pneumoniainvolvingpartialorwholelung T3atelectasis pneumoniainvolvingwholelung 12 2019 12 19 Theprognosisofatelectasis pneumoniainvolvingpartiallungisconsistentwithotherfactorsT2inthecaseswiththepathologicandclinicalstages Atelectasis pneumoniainvolvingwholelung currentlyT3 theprognosisisbetterthanotherfactorsT3 P 0 001 Atelectasis pneumonia 13 2019 12 19 Tstagingadjustment involvingdiaphragmandmediastinalpleura 7thedition T3DirectinvasionofdiaphragmT3Directinvasionofmediastinalpleura upstagex Proposal T4Directinvasionofdiaphragmdelete 14 2019 12 19 PostoperativepathologyshowedtumorinvolvingdiaphragmofpT3hadworseprognosis ComparedwithotherpT3 p 0 004 ComparedwithpT4tumor p 0 02 Involvingdiaphragm 15 2019 12 19 TheprognosisofdiaphragmaticinvolvementissimilarwithotherclinicalstageT3 P 0 121 andT4 P 0 09 Involvingdiaphragm 16 2019 12 19 Involvingmediastinalpleura Prognosticroleofmediastinalpleuralinvolvement ComparedwithotherclinicalT3 thisT3tendstohaveabetterprognosis butonly20casesinthecurrentdatabase Butinthepathologicstage thispT3isworsethanotherfactorsofpT3 However themediastinalpleuralinvolvementisrarelyusedasstagingfactor Noobvioussignwhenthepleuralinvolvementofthemediastinalpleural Whentheinvasionofthemediastinalpleuralisfound itusuallyhascrossedthepleuraltothetissue whichbelongstotheT4category Inpathologicalstage itisraretoremainmediastinalpleuralinvasionwithoutinvasiontothemediastinaltissue Therefore IASLCStagingandPrognosticFactorsCommitteeremovedtheTstagingofmediastinalpleuralinvolvement 17 2019 12 19 Catalog Tstagingadjustment tumorsize involvingthemainbronchus atelectasis pneumonia involvingdiaphragmandmediastinalpleura Otherfactors visceralpleuralinvolvement tumornodulesindifferentlobesofipsilaterallung Deficienciesandissuesneedtobefurtherstudied 18 2019 12 19 Visceralpleuralinvolvement VisceralpleuralinvolvementiscurrentlyT2stagingfactors theanalysisshowsthatthelocationissuitable noneedtoadjust Evenbecorrectedbytumorsize itstillleadstoaworseprognosis 19 2019 12 19 Visceralpleuralinvolvement Furtheranalysisofpathologicalandclinicalstageshowedthat ifcombinedwiththevisceralpleuralinvolvement VPI willincreasetherisk Pathologicalstage tumorsize 3 4cmwithVPIissimilarwithtumorsize 4 5cm tumorsize 4 5cmwithVPIissimilarwithtumorsize 5 7cm Butthesedifferencesarenotclearinclinicalstages Thiscanbeusedasthebasisforupstaging butthediscoveryfrompathologicalstagingisnotcommoninclinicalstaging andclinicalassessmentofVPIisnotreliable 20 2019 12 19 Tumornodulesindifferentlobesofipsilaterallung Limitedtothenumberofpatients limitedsignificance ComparewithotherT4 caseswithtumornodulesindifferentlobesofipsilaterallunghasworseprognosis Comparewithsinglenodule caseswithmultiplenoduleshaveworseprognosis 21 2019 12 19 Catalog Tstagingadjustment tumorsize involvingthemainbronchus atelectasis pneumonia involvingdiaphragmandmediastinalpleura Otherfactors visceralpleuralinvolvement tumornodulesindifferentlobesofipsilaterallung Deficienciesandissuesneedtobefurtherstudied 22 2019 12 19 Deficiencies AlotofanalysisofthedataisnotspecificallydesignedforthestudyofTNMstages sothelackofdetailedinformation butfortheanalysisofthefollowinginformationisreliableandexact Tumorsize thisisaroutinerecord Bronchialposition Atelectasis pneumonia VisceralpleuralinvolvementInvolvingdiaphragmIncontrasttothepreviousanalysisoftheseventheditionoftheTNMstagingdatabase theAsianpopulationaccountedforaparticularlyprominent Thepopulationratiohasbeenadjustedbyregion EGFRmutationstatusinpatientswithlungadenocarcinomaisunknown 23 2019 12 19 Issuesneedtobefurtherstudied Fortumorswithsmalllesions whichareworthyoffurtherstudy Growthrate Tumordensity solid partialsolid pureGGO PETuptakeintensity Resectiontype Non surgicaltreatment Molecularcharacteristics Geneticcharacteristics Inthisdatabase wecannotsolvetheproblemofthemethodofmeasuringpartialsolid IASLChassetupabranchtosolvethisproblem andgiverecommendationsintheformofwhitepaper UICC srecommendationistomeasuretheinvasivecomponentofthetumorasareferenceforTstaging 24 2019 12 19 Pathologic all Events NMST60MonthN05694 22938NR75 N11842 381157 549 N22674 452235 036 N3113 15519 120 0 100 80 60 40 20 0 YEARSAFTERRESECTION AsamuraHetal JThoracOncol2015 inpress N0vsN1vsN2vsN3ComparisonsAdjustedforHistology adenovsothers Sex Age60 R0resection andRegion CoxPHregressiononallcases comparisonN1vsN0N2vsN1N3vsN2 HR2 131 741 66 P 0 0001 0 0001 0 0001 N result 25 2019 12 19 Pathological anyR LocationandNumberofPosStationsN1 N2AnyR 1 2 3 4 5 0 N1N1N2N2N2 SiMSiSiM nglultnglnglult Events NMST60438 1135NR153 32560 9261 60267 0N1 58243 9N2 79638 0 Month58 50 52 41 36 N1Single N1a N1Multiple N1bN2SingleN2 skipmets N2a1 N2SingleN2 N1 N2a2N2MultipleN2 N2b N1avsN1bvsN2a1vsN2a2vsN2bComparisonsAdjustedforHistology adenovsothers Sex Age60 R0Resection andRegion CoxPHregressiononAllcases comparisonN1bvsN1aN2a1 skip vsN1bN2a2vsN2a1 skip N2bvsN2a2N2a2vsN1b HR1 380 921 371 211 26 P0 00050 43310 00020 01170 0197 N result 26 2019 12 19 Recommendations Keepingthecurrentdescriptiongenerally Presentingnewopinions pN1a singlepN1pN1b multiplepN1pN2a1 singlepN2 nonepN1 skip pN2 pN2a2 singlepN2withpN1pN2b multiplepN2 27 2019 12 19