<br>将 T2 类别细分为 T2a 和 T2b 在乳腺癌 TNM 分期中的临床意义,Cancer Medicine

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将 T2 类别细分为 T2a 和 T2b 在乳腺癌 TNM 分期中的临床意义
Cancer Medicine ( IF 2.9 ) Pub Date : 2018-10-12 , DOI: 10.1002/cam4.1831
Jiwoong Jung ₁ , Young Jin Suh ₂ , Byung Kyun Ko ₃ , Eun Sook Lee ₄ , Eun-Kyu Kim ₅ , Nam Sun Paik ₆ , Kyung Do Byun ₇ , Ki-Tae Hwang ₈

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关于乳腺癌的 TNM 分期，T2 类别目前未划分为子类别，尽管它比 T1 类别涵盖的肿瘤大小范围更广。使用韩国乳腺癌登记数据库，对 2001 年至 2014 年间诊断为非转移性 T2 乳腺癌的 41 071 名女性的数据进行了分析。最佳肿瘤大小的截止值通过接受者操作特征（ROC）曲线来近似，以对 T2 肿瘤进行细分。比较两个子类别之间的总生存期 (OS)。中位随访期为 65 个月。在 41 071 名患者中，4504 名患者（11.0%）死亡。根据ROC曲线分析，选择3.0 cm作为截止值。乳腺肿瘤≤3.0 cm (T2a) 的患者的五年 OS 率为 91%，乳腺肿瘤 >3.0 cm (T2b) 的患者的五年 OS 率为 86%（对数秩P <） 0.001）。无论节点状态如何，T2b 子类别的 OS 均比 T2a 子类别差（对数秩P < 所有节点类别为 0.001）。在主要 OS 分析协变量定义的每个亚组中，T2b 亚类始终表现出比 T2a 亚类更差的结果。通过多变量分析，T2b 亚类是 OS 的显着独立预后因素（风险比：1.26，95% CI = 1.18‐1.34）。 T2型乳腺癌可分为T2a和T2b，截断值为3cm。即使在根据已知的预后因素进行调整后，这些子类别也肯定显示出不同的操作系统。 T2 类别的子分类可能有助于更准确地预测预后和调整辅助治疗。

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Clinical implication of subcategorizing T2 category into T2a and T2b in TNM staging of breast cancer

Regarding TNM staging in breast cancer, T2 category is currently not divided into subcategories even though it covers a wider range of tumor sizes than T1 category. Using Korean Breast Cancer Registry database, data of 41 071 women diagnosed as non‐metastatic T2 breast cancer between 2001 and 2014 were analyzed. Cutoff value for optimal tumor size was approximated by receiver operating characteristic (ROC) curve to subcategorize T2 tumors. Overall survival (OS) was compared between two subcategories. Median follow‐up period was 65 months. Of 41 071 patients, 4504 (11.0%) died. Based on ROC curve analysis, 3.0 cm was selected as the cutoff value. Five‐year OS rate was 91% in patients with breast tumors ≤3.0 cm (T2a) and 86% in patients with breast tumors >3.0 cm (T2b) (log‐rank P < 0.001). T2b subcategory showed worse OS than T2a subcategory regardless of node status (log‐rank P < 0.001 for all node categories). Within every subgroup defined by primary OS analysis covariates, T2b subcategory consistently showed worse outcome compared to T2a subcategory. By multivariate analysis, T2b subcategory was a significant independent prognostic factor of OS (hazard ratio: 1.26, 95% CI = 1.18‐1.34). T2 category of breast cancer could be subcategorized into T2a and T2b with a cutoff value of 3 cm. These subcategories definitely showed different OSs even after adjusted for known prognostic factors. Subcategorization of T2 category might be useful for predicting prognosis more accurately and tailoring adjuvant therapy.

更新日期：2018-10-12

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