Introduction: The eighth edition of the TNM staging system included the proposal that the T descriptor be determined according to the invasive component, excluding lepidic component, for nonmucinous lung adenocarcinomas. We sought to conduct a clinicopathologic comparative analysis of the newly proposed classification using invasive size versus total tumor size. Methods: Patients who underwent lung resection for primary lung adenocarcinoma with pathologic stage (p‐Stage) I‐IIA (based on total size [t]) were reviewed (n = 1704). Pathologic invasive size was measured, and tumors were reclassified using invasive size (i). Cumulative incidence of recurrence and lung cancer–specific cumulative incidence of death were analyzed using a competing‐risks approach. Prognostic discrimination by p‐Stage(t) and p‐Stage(i) was evaluated using a concordance index (C‐index). Results: The use of invasive size resulted in downstaging in 377 of 1704 patients (22%), with twice as many patients with p‐Stage IA1 (IA1[i] versus IA1[t]: 389 [23%] versus 195 [11%]). However, outcomes were similar between the two groups (IA1[i] versus IA1[t]: 5‐year cumulative incidence of recurrence, 11% versus 13%; 5‐year lung cancer–specific cumulative incidence of death, 5% versus 7%). Prognostic discrimination by p‐Stage(i) was better than by p‐Stage(t) (C‐index for p‐Stage[i] versus p‐Stage[t]: recurrence, 0.614 versus 0.593; lung cancer–specific death, 0.634 versus 0.621). Conclusions: When invasive size, rather than total size, was used for the T descriptor, a larger number of patients were classified with a favorable prognosis (p‐Stage IA1) and better prognostic discrimination of p‐Stage I‐IIA nonmucinous lung adenocarcinomas was achieved.

中文翻译：

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TNM 提案第八版的意义：病理 I-IIA 期肺腺癌中 T 描述符的侵袭性与总肿瘤大小


简介：第八版 TNM 分期系统建议根据非粘液性肺腺癌的侵袭性成分确定 T 描述符，排除鳞屑性成分。我们试图使用侵入性大小与肿瘤总大小对新提出的分类进行临床病理学比较分析。方法：对病理分期（p 期）I-IIA（基于总大小 [t]）的原发性肺腺癌接受肺切除术的患者进行回顾（n = 1704）。测量病理浸润尺寸，并使用浸润尺寸对肿瘤进行重新分类(i)。使用竞争风险方法分析累积复发率和肺癌特定累积死亡发生率。使用一致性指数（C-指数）评估 p-Stage(t) 和 p-Stage(i) 的预后判别。结果：使用侵入性尺寸导致 1704 名患者中的 377 名患者 (22%) 降期，其中 p 期 IA1 患者的数量是其两倍（IA1[i] vs IA1[t]：389 [23%] vs 195 [11] %]）。然而，两组之间的结果相似（IA1[i] 与 IA1[t]：5 年累积复发率，11% 对 13%；5 年肺癌特异性累积死亡发生率，5% 对 7 %）。 p-Stage(i) 的预后判别优于 p-Stage(t)（p-Stage[i] 与 p-Stage[t] 的 C 指数：复发，0.614 对比 0.593；肺癌特异性死亡， 0.634 与 0.621）。结论：当使用浸润性大小而不是总大小作为 T 描述符时，更多的患者被分类为预后良好（p-IA1 期），并且 p-I-IIA 期非粘液性肺腺癌的预后更好实现了。