Department of Clinical Oncology, Aichi Cancer Center Hospital, Japan.
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):946-52. doi: 10.1016/j.ijrobp.2010.12.045. Epub 2011 Feb 28.
The new 7th edition of the American Joint Committee on Cancer TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. There is no information available on evaluation of the new staging system with regard to prognosis of patients treated with chemoradiotherapy (CRT). The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal cancer patients treated with CRT.
A retrospective review was performed on 301 consecutive esophageal squamous cell carcinoma patients treated with CRT. Comparisons were made of the prognostic impacts of the 6th and 7th staging systems and the prognostic impacts of stage and prognostic groups, which were newly defined in the 7th edition.
There were significant differences between Stages I and III (p < 0.01) according to both editions. However, the 7th edition poorly distinguishes the prognoses of Stages III and IV (p = 0.36 by multivariate analysis) in comparison to the 6th edition (p = 0.08 by multivariate analysis), although these differences were not significant. For all patients, T, M, and gender were independent prognostic factors by multivariate analysis (p < 0.05). For the Stage I and II prognostic groups, survival curves showed a stepwise decrease with increase in stage, except for Stage IIA. However, there were no significant differences seen between each prognostic stage.
Our study indicates there are several problems with the 7th TNM staging system regarding prognostic factors in patients undergoing CRT.
第 7 版美国癌症联合委员会 TNM 分期系统基于单独接受手术治疗的食管癌患者的病理数据。目前尚无关于新分期系统对接受放化疗（CRT）治疗的患者预后评估的信息。本研究的目的是评估新分期系统对接受 CRT 治疗的食管癌患者的预后影响。
对 301 例连续接受 CRT 治疗的食管鳞状细胞癌患者进行回顾性研究。比较了第 6 版和第 7 版分期系统的预后影响，以及第 7 版新定义的分期和预后组的预后影响。
根据两个版本，I 期和 III 期之间存在显著差异（p < 0.01）。然而，与第 6 版相比（p = 0.08 多因素分析），第 7 版在区分 III 期和 IV 期的预后方面较差（p = 0.36 多因素分析），尽管这些差异没有统计学意义。对于所有患者，T、M 和性别是多因素分析的独立预后因素（p < 0.05）。对于 I 期和 II 期预后组，生存曲线显示随着分期的增加呈逐步下降，除了 IIA 期。然而，在每个预后阶段之间没有观察到显著差异。
我们的研究表明，对于接受 CRT 的患者，第 7 版 TNM 分期系统在预后因素方面存在几个问题。
