基于监测、流行病学和最终结果以及直肠汇总分析结果修订的直肠癌肿瘤和淋巴结分类。
Revised tumor and node categorization for rectal cancer based on surveillance, epidemiology, and end results and rectal pooled analysis outcomes.
机构信息
Mayo Clinic Cancer Center-Arizona, 13400 East Shea Blvd, Scottsdale, AZ 85259, USA.
出版信息
J Clin Oncol. 2010 Jan 10;28(2):256-63. doi: 10.1200/JCO.2009.23.9194. Epub 2009 Nov 30.
PURPOSE
The sixth edition of the American Joint Committee on Cancer (AJCC) rectal cancer staging subdivided stage II into IIA (T3N0) and IIB (T4N0) and stage III into IIIA (T1-2N1M0), IIIB (T3-4N1M0), and IIIC (anyTN2M0). Subsequent analyses supported revised substaging of stage III as a result of improved survival with T1-2N2 versus T3-4N2 and survival of T4N1 more similar to T3-4N2 than T3N1. The AJCC Hindgut Taskforce sought population-based validation that depth of invasion interacts with nodal status to affect survival.
METHODS
Surveillance, Epidemiology, and End Results (SEER) population-based data from January 1992 to December 2004 for 35,829 patients with rectal cancer were compared with rectal pooled analysis data (3,791 patients). T4N0 cancers were stratified by tumors that perforate visceral peritoneum (T4a) versus tumors that invade or are adherent to adjacent organs or structures (T4b). N1 and N2 were stratified by number of positive nodes as follows: N1a/N1b (one v two to three nodes) and N2a/N2b (four to six v > or = seven nodes). Five-year observed and relative survival rates were obtained for each TN category.
RESULTS
SEER rectal cancer analyses confirm that T1-2N2 cancers have better prognosis than T3-4N2, T4bN1 have similar prognosis to T4N2, T1-2N1 have similar prognosis to T2N0/T3N0, and T1-2N2a have similar prognosis to T2N0/T3N0 (T1N2a) or T4aN0 (T2N2a). Prognosis for T4a lesions is better than T4b by N category. The number of positive nodes affects prognosis.
CONCLUSION
This SEER population-based rectal cancer analysis validates the rectal pooled analyses and supports the shift of T1-2N2 lesions from IIIC to IIIA or IIIB and T4bN1 from IIIB to IIIC. SEER outcomes support subdividing T4, N1, and N2 and revised substaging of stages II and III. Survival by TN category suggests a complex biologic interaction between depth of invasion and nodal status.
目的
第六版美国癌症联合委员会（AJCC）直肠癌分期将 II 期细分为 IIA（T3N0）和 IIB（T4N0），将 III 期细分为 IIIA（T1-2N1M0）、IIIB（T3-4N1M0）和 IIIC（任何 T、N2M0）。随后的分析支持对 III 期进行修订亚分期，因为 T1-2N2 与 T3-4N2 的生存率提高，T4N1 的生存率与 T3-4N2 更相似，而与 T3N1 不同。AJCC 下消化道工作组寻求基于人群的验证，即浸润深度与淋巴结状态相互作用影响生存。
方法
比较了 1992 年 1 月至 2004 年 12 月来自 Surveillance, Epidemiology, and End Results（SEER）的 35829 例直肠癌患者和直肠汇总分析数据（3791 例）。T4N0 肿瘤根据穿透内脏腹膜的肿瘤（T4a）与侵犯或粘附于相邻器官或结构的肿瘤（T4b）进行分层。N1 和 N2 根据阳性淋巴结的数量分层如下：N1a/N1b（一个 v 两个至三个淋巴结）和 N2a/N2b（四个至六个 v > = 七个淋巴结）。对于每个 TN 类别，获得了五年的观察和相对生存率。
结果
SEER 直肠癌分析证实，T1-2N2 肿瘤的预后优于 T3-4N2，T4bN1 的预后与 T4N2 相似，T1-2N1 的预后与 T2N0/T3N0 相似，T1-2N2a 的预后与 T2N0/T3N0（T1N2a）或 T4aN0（T2N2a）相似。根据 N 分类，T4a 病变的预后优于 T4b。阳性淋巴结的数量影响预后。
结论
这项基于 SEER 的直肠癌分析验证了直肠汇总分析，并支持将 T1-2N2 病变从 IIIIC 转移到 IIIA 或 IIIB，以及 T4bN1 从 IIIB 转移到 IIIC。SEER 结果支持 T4、N1 和 N2 的细分以及 II 期和 III 期的修订亚分期。根据 TN 分类的生存率表明，浸润深度和淋巴结状态之间存在复杂的生物学相互作用。
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