TNM7 与 TNM6 分期评估食管癌的相对预后价值。

Relative prognostic value of TNM7 vs TNM6 in staging oesophageal cancer.

机构信息

Department of Surgery, South East Wales Cancer Network, University Hospital of Wales, Cardiff, UK.

出版信息

Br J Cancer. 2011 Sep 6;105(6):842-6. doi: 10.1038/bjc.2011.320. Epub 2011 Aug 16.

DOI:10.1038/bjc.2011.320

PMID:21847117

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3171019/

Abstract

BACKGROUND

Stage migration consequent upon new cancer staging definitions may result in artifactual alterations in stage-specific survival and prognosis. The aim of this study was to determine the influence of the new TNM7 oesophageal cancer (OC) system on stage categorisation and survival when compared with historical controls.

METHODS

A total of 202 patients diagnosed with operable OC and undergoing oesophagectomy (118 neoadjuvant chemotherapy) were studied. Patients originally classified and staged using TNM6 were retrospectively re-staged using TNM7.

RESULTS

Re-classification of TNM7 resulted in stage migration in 11.9% of patients (9.9% downstaged, 2.0% upstaged) when compared with TNM6. Five-year survival for stages I, II and III was 78%, 46% and 18% using TNM6, compared with 62%, 51% and 18%, respectively, using TNM7. Univariable analysis revealed that histological grade (P = 0.006), pT (P < 0.0001), TNM6 pN (P < 0.0001), TNM7 pN (P < 0.0001), number of lymph node metastases (P < 0.0001), TNM6 stage group (P < 0.0001), TNM7 stage group (P < 0.0001) and TNM7 prognostic group (P < 0.0001) were all associated with survival. Multivariable analysis revealed that only the TNM7 prognostic group was independently and significantly associated with survival.

CONCLUSION

TNM7 is a better prognostic tool than TNM6 and represents an important advance in staging OC.

摘要

背景

新的癌症分期定义导致的分期迁移可能导致特定分期的生存和预后出现人为改变。本研究的目的是确定与历史对照相比，新的 TNM7 食管癌（OC）系统对分期分类和生存的影响。

方法

共研究了 202 例可手术治疗的 OC 患者，这些患者接受了食管切除术（118 例接受新辅助化疗）。最初使用 TNM6 进行分类和分期的患者，使用 TNM7 进行回顾性再分期。

结果

与 TNM6 相比，TNM7 的重新分类导致 11.9%的患者分期迁移（9.9%降期，2.0%升期）。TNM6 分期的 I、II 和 III 期的 5 年生存率分别为 78%、46%和 18%，而 TNM7 分期的分别为 62%、51%和 18%。单变量分析显示，组织学分级（P=0.006）、pT（P<0.0001）、TNM6 pN（P<0.0001）、TNM7 pN（P<0.0001）、淋巴结转移数（P<0.0001）、TNM6 分期组（P<0.0001）、TNM7 分期组（P<0.0001）和 TNM7 预后组（P<0.0001）均与生存相关。多变量分析显示，只有 TNM7 预后组与生存独立且显著相关。