State Key Laboratory of Oncology in South China, Guangzhou, China.
Ann Surg Oncol. 2011 Jul;18(7):1869-76. doi: 10.1245/s10434-010-1542-x. Epub 2011 Jan 19.
The 7th edition of American Joint Committee on Cancer tumor-node-metastasis (AJCC TNM) staging system was put into use recently. The study aimed to evaluate its predictive ability on survival and compare the difference between the 6th and 7th editions of AJCC TNM system in gastric carcinoma.
A total of 1000 gastric carcinoma patients receiving treatment in our center were selected for the analysis. Patients were staged using both the 6th and 7th editions AJCC TNM staging system. Survival analysis was performed with a Cox regression model.
Of previous stage IV patients, 39.9% (112 of 281) migrated to a lower tier in the 7th edition. By setting the cutoff of positive lymph nodes as 0, 2, 6, and 15, the 7th edition strengthens the role of positive lymph nodes. Multivariable regression analysis showed that both 6th and 7th TNM stage systems were independent factors for overall survival. For lymph nodes negative patients, the 5-year overall survival for patients with fewer than 15 resected lymph nodes was significantly lower than those with more than 15.
AJCC 7th is not superior to AJCC 6th in predicting the 5-year overall survival rates of gastric adenocarcinoma patients. The definition of stage IV and the selection of cutoffs for MLNC in the AJCC 7th system is much more reasonable compared with the AJCC 6th system.
最近，第 7 版美国癌症联合委员会肿瘤-淋巴结-转移（AJCC TNM）分期系统开始使用。本研究旨在评估其对生存的预测能力，并比较胃癌中第 6 版和第 7 版 AJCC TNM 系统的差异。
本研究共纳入 1000 例在我院接受治疗的胃癌患者进行分析。患者采用第 6 版和第 7 版 AJCC TNM 分期系统进行分期。采用 Cox 回归模型进行生存分析。
在以前的第 IV 期患者中，39.9%（281 例中的 112 例）在第 7 版中降期。通过将阳性淋巴结的截断值设置为 0、2、6 和 15，第 7 版增强了阳性淋巴结的作用。多变量回归分析显示，第 6 版和第 7 版 TNM 分期系统均为总生存的独立因素。对于淋巴结阴性的患者，少于 15 个切除淋巴结的患者 5 年总生存率明显低于多于 15 个淋巴结的患者。
与第 6 版相比，第 7 版 AJCC 在预测胃腺癌患者 5 年总生存率方面并不优越。第 7 版 AJCC 中 IV 期的定义和 MLNC 的截断值选择比第 6 版更加合理。
