Department of Surgery, Chutung Veterans Hospital, Hsinchu county, and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Ann Thorac Surg. 2010 Apr;89(4):1024-31. doi: 10.1016/j.athoracsur.2010.01.017.
The 7th edition American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM) staging system was published recently. We aim to evaluate its predictive ability and to compare the performance of the 6th and 7th editions of the AJCC TNM staging systems in esophageal cancer.
A total of 392 esophageal squamous cell carcinoma patients receiving primary surgical resection between 1995 and 2006 were included. Patients were staged using the 6th and 7th edition staging systems. Survival analysis was performed with a Cox regression model. The homogeneity, discriminatory ability, and monotonicity of gradients of two staging systems were compared using linear trend chi2, likelihood ratio chi2 statistics, and Akaike information criterion calculation.
The overall five-year survival rate for the entire cohort was 27.1%. Female gender, "T," "N," and "M" classifications according to the 7th edition staging system definition were independent prognostic factors in multivariate analysis. But histology grade and cancer location had no significant influence on patient survival. The 7th edition staging system has the highest linear trend chi2 and likelihood ratio chi2 scores. Compared with the 6th edition, the 7th edition staging system also has a smaller Akaike information criterion value, which represented the optimum prognostic stratification.
The strength of the 7th edition AJCC TNM staging system is the new descriptors for "N" and "M" classifications. However, we did not find histologic grade and cancer location to be significant prognostic factors in our cohort. Overall, the 7th edition AJCC TNM staging system has better performance than the previous edition.
第七版美国癌症联合委员会（AJCC）肿瘤-淋巴结-转移（TNM）分期系统最近发布。我们旨在评估其预测能力，并比较第六版和第七版 AJCC TNM 分期系统在食管癌中的表现。
共纳入 1995 年至 2006 年间接受根治性手术的 392 例食管鳞状细胞癌患者。患者分期采用第六版和第七版分期系统。采用 Cox 回归模型进行生存分析。使用线性趋势 χ2、似然比 χ2 统计量和赤池信息量准则（Akaike information criterion，AIC）计算比较两种分期系统的同质性、区分能力和梯度单调性。
全队列的总体五年生存率为 27.1%。女性性别、第七版分期系统定义的“T”、“N”和“M”分类是多因素分析中的独立预后因素。但组织学分级和肿瘤位置对患者生存无显著影响。第七版分期系统具有最高的线性趋势 χ2 和似然比 χ2 得分。与第六版相比，第七版分期系统的 AIC 值更小，代表了最佳的预后分层。
第七版 AJCC TNM 分期系统的优势在于“N”和“M”分类的新描述符。然而，我们在本队列中并未发现组织学分级和肿瘤位置是显著的预后因素。总体而言，第七版 AJCC TNM 分期系统的性能优于上一版。
