Dabrowski Andrzej, Skoczylas Tomasz, Ciechański Aleksander, Wallner Grzegorz, Zinkiewicz Krzysztof, Cwik Grzegorz, Górczyński Rafał, Borowski A
Second Department of General Surgery, Skubiszewski Medical University, Lublin, Poland.
Med Sci Monit. 2006 Oct;12(10):CR409-15. Epub 2006 Sep 25.
Several disadvantages of the TNM classification have resulted in a search for a simpler, clearer, and more reliable staging system for esophageal cancer. We evaluated Dukes' classification as a prognostic indicator in 81 patients with squamous cell carcinoma of the thoracic esophagus treated with combined-modality therapy.
MATERIAL/METHODS: The pathological staging was determined according to the TNM and Dukes' classification. The cumulative survival rates were calculated using the Kaplan-Meier method. The differences in survival between the patients in particular stages of both classifications were estimated with the log-rank test.
The differences in cumulative survival rates between TNM I and TNM IIa, between TNM IIa and TNM IIb and between TNM IIb and TNM III patients were 20.2% (37.2 vs. 46.6), 27.5% (46.6 vs. 33.8) and 60.7% (33.8 vs. 13.3), respectively, and were not statistically significant (P = 0.58, P = 0.53 and P = 0.18). The cumulative survival rates for TNM III and TNM IV patients were similar (13.3 and 14.3). The difference in cumulative survival rates between Dukes' A and B patients amounted to 52.5% (54.3 vs. 25.8), which was statistically significant (P = 0.02). The difference in cumulative survival rates between Dukes' B and C patients was 41.5% (25.8 vs. 15.1), but fell short of statistical significance (P = 0.12). The cumulative survival rates for Dukes' C and D patients were similar (15.1 and 16.6).
Dukes' staging system for esophageal cancer is simpler, clearer and more accurate, and could thus be a better prognostic tool than the TNM classification.
TNM 分期存在若干缺点，因此人们一直在寻找一种更简单、更清晰且更可靠的食管癌分期系统。我们评估了 Dukes 分期作为 81 例接受综合治疗的胸段食管鳞状细胞癌患者预后指标的情况。
材料/方法：根据 TNM 和 Dukes 分期确定病理分期。采用 Kaplan-Meier 方法计算累积生存率。用对数秩检验评估两种分期特定阶段患者的生存差异。
TNM I 期与 TNM IIa 期、TNM IIa 期与 TNM IIb 期以及 TNM IIb 期与 TNM III 期患者的累积生存率差异分别为 20.2%（37.2%对 46.6%）、27.5%（46.6%对 33.8%）和 60.7%（33.8%对 13.3%），差异无统计学意义（P = 0.58、P = 0.53 和 P = 0.18）。TNM III 期和 TNM IV 期患者的累积生存率相似（13.3%和 14.3%）。Dukes' A 期与 B 期患者的累积生存率差异为 52.5%（54.3%对 25.8%），差异有统计学意义（P = 0.02）。Dukes' B 期与 C 期患者的累积生存率差异为 41.5%（25.8%对 15.1%），但未达到统计学意义（P = 0.12）。Dukes' C 期和 D 期患者的累积生存率相似（15.1%和 16.6%）。
食管癌的 Dukes 分期系统更简单、更清晰且更准确，因此可能是比 TNM 分期更好的预后工具。
