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在单中心研究中，第七版最新版结直肠癌 TNM 分类未能改善预后预测。

Prediction of prognosis is not improved by the seventh and latest edition of the TNM classification for colorectal cancer in a single-center collective.

机构信息

Department of Surgery, Technische Universität München, Munich, Germany.

出版信息

Ann Surg. 2011 Nov;254(5):793-800; discussion 800-1. doi: 10.1097/SLA.0b013e3182369101.

DOI:10.1097/SLA.0b013e3182369101

PMID:22042471

Abstract

OBJECTIVES

To compare the prognostic value of the sixth and seventh editions of the TNM classification, and of additional prognostic factors, in colorectal cancer.

BACKGROUND

The seventh TNM edition was released in 2009 with the aim of providing a more precise prediction of prognosis.

METHODS

Clinical and histopathological data of 2229 patients with colorectal cancer who underwent tumor resection between 1990 and 2006 were analyzed and compared by using the sixth and seventh editions of the TNM classification and a statistically calculated model of prognostic factors.

RESULTS

With the sixth edition, 5-year survival was 96% for stage I, 90% for IIA, 86% for IIB, 90% for IIIA, 72% for IIIB, 48% for IIIC, and 13% for IV. With the seventh edition, 5-year survival was 96% for stage I, 90% for IIA, 84% for IIB, 87% for IIC, 89% for IIIA, 72% for IIIB, 36% for IIIC, 15% for IVA, and 10% for IVB. The stage shifted for only 155 (7%) patients: from IIB to IIC (2%), from IIIB to IIIC (1%), and from IIIC to IIIA/B (4%). The performance of the seventh edition [concordance index (c-index) 0.83; 95% confidence interval (CI), 0.82-0.85] revealed no relevant improvement compared with the sixth edition (c-index 0.83; 95% CI, 0.82-0.84), or compared to a model based on independent prognostic factors (c-index 0.84; 95% CI, 0.83-0.86).

CONCLUSIONS

The seventh TNM edition did not provide greater accuracy in predicting colorectal cancer patients' prognosis but resulted in a more complex classification for daily clinical use.

摘要

目的

比较第六版和第七版 TNM 分期以及其他预后因素在结直肠癌中的预后价值。

背景

第七版 TNM 分期于 2009 年发布，旨在提供更准确的预后预测。

方法

分析并比较了 1990 年至 2006 年间接受肿瘤切除术的 2229 例结直肠癌患者的临床和组织病理学数据，使用第六版和第七版 TNM 分期以及统计计算的预后因素模型进行比较。

结果

第六版的 5 年生存率为 I 期 96%、IIA 期 90%、IIB 期 86%、IIIA 期 90%、IIIB 期 72%、IIIC 期 48%和 IV 期 13%。第七版的 5 年生存率为 I 期 96%、IIA 期 90%、IIB 期 84%、IIC 期 87%、IIIA 期 89%、IIIB 期 72%、IIIC 期 36%、IVA 期 15%和 IVB 期 10%。只有 155 名（7%）患者分期发生变化：从 IIB 期变为 IIC 期（2%）、从 IIIB 期变为 IIIC 期（1%）、从 IIIC 期变为 IIIA/B 期（4%）。第七版的性能[一致性指数（c-index）0.83；95%置信区间（CI），0.82-0.85]与第六版（c-index 0.83；95% CI，0.82-0.84）或基于独立预后因素的模型（c-index 0.84；95% CI，0.83-0.86）相比，没有显著提高。