Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL, USA.
J Clin Oncol. 2011 Aug 1;29(22):3044-9. doi: 10.1200/JCO.2011.35.1817. Epub 2011 Jun 27.
The American Joint Committee on Cancer (AJCC) staging manual (seventh edition) has introduced its first TNM staging classification for pancreatic neuroendocrine tumors (NETs) derived from the staging algorithm for exocrine pancreatic adenocarcinomas. This classification has not yet been validated.
Patients with pancreatic NETs treated at the H. Lee Moffitt Cancer Center between 1999 and 2010 were assigned a stage (I to IV) based on the new AJCC classification. Kaplan-Meier analyses for overall survival (OS) were performed based on age, race, histologic grade, incidental diagnosis, and TNM staging (European Neuroendocrine Tumors Society [ENETS] v AJCC) using log-rank tests. Survival time was measured from time of initial diagnosis to date of last contact or date of death. Multivariate modeling was performed using Cox proportional hazards regression. Weighted Cohen's κ coefficient was computed to evaluate the agreement of ENETS and AJCC classifications.
We identified 425 patients with pancreatic NETs. On the basis of histopathologic grade, 5-year survival rates for low-, intermediate-, and high-grade tumors were 75%, 62%, and 7%, respectively (P < .001). When using the ENETS classification, 5-year OS rates for stages I, II, III, and IV were 100%, 88%, 85%, and 57%, respectively (P < .001). Subsequently, using the AJCC classification, 5-year OS rates for stages I, II, III, and IV were 92%, 84%, 81%, and 57%, respectively (P < .001). Both the novel AJCC classification and the ENETS classification were highly prognostic for survival.
The AJCC TNM classification for pancreatic NETs is prognostic for OS and can be adopted in clinical practice.
美国癌症联合委员会（AJCC）分期手册（第七版）首次为源自外分泌胰腺腺癌分期算法的胰腺神经内分泌肿瘤（NET）引入了其首个 TNM 分期分类。该分类尚未得到验证。
根据新的 AJCC 分类，1999 年至 2010 年在 H. Lee Moffitt 癌症中心治疗的胰腺 NET 患者被分配了一个分期（I 期至 IV 期）。使用对数秩检验对总生存期（OS）进行 Kaplan-Meier 分析，分析因素包括年龄、种族、组织学分级、偶然诊断和 TNM 分期（欧洲神经内分泌肿瘤学会[ENETS]与 AJCC）。生存时间从初始诊断日期到最后一次随访日期或死亡日期进行测量。使用 Cox 比例风险回归进行多变量建模。计算加权 Cohen's κ 系数以评估 ENETS 和 AJCC 分类的一致性。
我们确定了 425 名患有胰腺 NET 的患者。根据组织病理学分级，低、中、高级别肿瘤的 5 年生存率分别为 75%、62%和 7%（P <.001）。使用 ENETS 分类时，I、II、III 和 IV 期的 5 年 OS 率分别为 100%、88%、85%和 57%（P <.001）。随后，使用 AJCC 分类，I、II、III 和 IV 期的 5 年 OS 率分别为 92%、84%、81%和 57%（P <.001）。新的 AJCC 分类和 ENETS 分类对生存均具有高度预后价值。
AJCC 用于胰腺 NET 的 TNM 分类对 OS 具有预后价值，并可在临床实践中采用。
