Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, 201 Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
World J Surg. 2011 Dec;35(12):2723-9. doi: 10.1007/s00268-011-1275-4.
The AJCC 7th edition changes the classification of T- and N-factors and the TNM stage of gastric cancer. We evaluated its prognostic impact.
From December 1987 to December 2006, a total of 1,380 patients underwent curative surgery for gastric cancer at the Department of Surgery, Taipei Veterans General Hospital, with a retrieved lymph node number ≥ 15. Survival was compared for disease classified according to the AJCC 6th and 7th editions.
There is a significant difference in 5-year survival between T2 and T3 gastric cancer classified according to the AJCC 7th edition (75.2 vs. 54.9%, p < 0.001), as well as between N1 and N2 (71.4 vs. 44.1%, p < 0.001). Although patients with N3a had a better 5-year survival than did those with N3b (27.6 vs. 11.3%, p < 0.001), the N3 categories were combined and not applied in the TNM stage in the 7th edition. Multivariate analysis using Cox's proportional hazards model with a forward logistics regression stepwise procedure demonstrates that age, N category of 6th edition, and T and N categories of 7th edition are independent prognostic factors; however, T category of 6th edition is no longer significant. Furthermore, the discriminative power of survival difference between each TNM stage seems to be comparable between the 6th and 7th editions.
The AJCC 7th edition provides a more stratified survival difference in staging of gastric cancer. Future division of N3a and N3b in the classification of the TNM stage is recommended.
AJCC 第 7 版改变了胃癌 T 分期和 N 分期以及 TNM 分期。我们评估了其预后影响。
1987 年 12 月至 2006 年 12 月，台湾荣民总医院外科共对 1380 例胃癌根治性手术患者进行了研究，这些患者的淋巴结清扫数≥15。根据 AJCC 第 6 版和第 7 版进行疾病分类，比较生存情况。
根据 AJCC 第 7 版，T2 和 T3 胃癌的 5 年生存率存在显著差异（75.2% vs. 54.9%，p<0.001），N1 和 N2 之间也存在显著差异（71.4% vs. 44.1%，p<0.001）。虽然 N3a 期患者的 5 年生存率优于 N3b 期（27.6% vs. 11.3%，p<0.001），但在第 7 版中，N3 分期被合并，并未应用于 TNM 分期。采用 Cox 比例风险模型的正向逐步逻辑回归多变量分析表明，年龄、第 6 版 N 分期、第 7 版 T 和 N 分期是独立的预后因素；然而，第 6 版 T 分期不再具有统计学意义。此外，第 6 版和第 7 版之间，每个 TNM 分期的生存差异的判别能力似乎相当。
AJCC 第 7 版为胃癌分期提供了更具分层的生存差异。建议未来在 TNM 分期分类中进一步划分 N3a 和 N3b。
