Introduction: The TNM classification for lung cancer, originally designed for NSCLC, is applied to staging of bronchopulmonary carcinoid tumors. The validity of the eighth edition of the staging system for carcinoid tumors has not been assessed. In this study, we evaluated its prognostic accuracy by using data from a large national population‐based cancer registry. Methods: Patients with typical and atypical bronchopulmonary carcinoids diagnosed between 2000 and 2013 were identified from the National Cancer Institute's Surveillance, Epidemiology and End Results registry. We used competing risks analysis to compare 10‐year disease‐specific survival (DSS) across stages. Results: Overall, 4645 patients with bronchopulmonary carcinoid tumors were identified. Worsening DSS with increasing TNM status and stage was demonstrated across both typical and atypical carcinoids, with overlaps between adjacent subcategories. The combined stages (I versus II, II versus III, and III versus IV) showed greater separation in DSS despite persistent overlaps between groups. For typical carcinoids, we found decreased DSS for stages II, III, and IV, with hazard ratios of 3.8 (95% confidence interval [CI]: 2.6–5.6), 4.3 (95% CI: 3.0–6.1), and 9.0 (95% CI: 6.1–13.1), respectively, compared with stage I. Conclusion: The combined stage categories of the eighth edition of the TNM staging system provide useful information on outcomes for typical and atypical carcinoids. However, persistent overlaps in combined stage and subcategories of the staging system limit the usefulness of the TNM staging system, particularly in intermediate stages. These limitations suggest the need for future further study and refinement.

中文翻译：

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肺类癌 TNM 分期指南的预后意义评估

简介：肺癌的 TNM 分类最初是为 NSCLC 设计的，适用于支气管肺类癌的分期。第八版类癌分期系统的有效性尚未评估。在这项研究中，我们通过使用来自大型全国人群癌症登记处的数据来评估其预后准确性。方法：从美国国家癌症研究所的监测、流行病学和最终结果登记处确定了 2000 年至 2013 年间诊断出的典型和非典型支气管肺类癌患者。我们使用竞争风险分析来比较不同阶段的 10 年疾病特异性生存率 (DSS)。结果：总共确定了 4645 名支气管肺类癌患者。在典型和非典型类癌中，随着 TNM 状态和分期的增加，DSS 恶化，相邻亚类之间存在重叠。尽管组间持续重叠，但组合阶段（I 对 II、II 对 III、III 对 IV）在 DSS 中显示出更大的分离。对于典型的类癌，我们发现 II、III 和 IV 期的 DSS 降低，风险比为 3.8（95% 置信区间 [CI]：2.6-5.6）、4.3（95% CI：3.0-6.1）和 9.0（ 95% CI：6.1–13.1)，分别与 I 期相比。 结论：TNM 分期系统第八版的组合分期类别提供了关于典型和非典型类癌结果的有用信息。然而，分期系统的组合分期和子类别的持续重叠限制了 TNM 分期系统的有用性，特别是在中间阶段。这些局限性表明需要进一步研究和完善。