第七版 TNM 分类的优越性取决于患者队列的总生存率：来自日本和英国的胃癌患者第六版和第七版 TNM 比较分析。
The superiority of the seventh edition of the TNM classification depends on the overall survival of the patient cohort: comparative analysis of the sixth and seventh TNM editions in patients with gastric cancer from Japan and the United Kingdom.
机构信息
Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan.
出版信息
Cancer. 2013 Apr 1;119(7):1330-7. doi: 10.1002/cncr.27928. Epub 2012 Dec 21.
BACKGROUND
The objective of this study was to investigate whether the seventh edition of the American Joint Committee on Cancer/International Union Against Cancer TNM classification (TNM7) had superior discriminatory ability over the sixth edition of the TNM classification (TNM6) in patients with gastric cancer regardless of their country of origin.
METHODS
In total, 538 patients from the Kanagawa Cancer Center Hospital (Yokohama, Japan) (KCCH) and 519 patients from the Leeds Teaching Hospitals National Health Service Trust (Leeds, United Kingdom) (LTHT) who underwent surgery for gastric cancer were selected. Overall survival was used for statistical analysis. Hazard ratios (HRs) were estimated with disease stage as a continuous variable to evaluate the discriminatory ability of the TNM stage groups. The estimates of log HRs (logHRs) for the TNM6 and the TNM7 stage groups were compared.
RESULTS
In the KCCH cohort, 82 patients (15%) were upstaged, and 26 patients (5%) were downstaged between TNM6 and TNM7 compared with 253 patients (49%) and 53 patients (10%), respectively, in the LTHT cohort. The logHRs for a 1-stage increase within TNM6 and TNM7 were 1.06 and 1.16, respectively, in the KCCH cohort and 0.57 and 0.79, respectively, in the LTHT cohort. The differences in logHRs between TNM6 and TNM7 were significant in each cohort (KCCH: logHR, 0.11; P = .024; LTHT: logHR, 0.21; P = .0002) and between the 2 cohorts.
CONCLUSIONS
TNM7 had superior discriminatory ability compared with TNM6 in both cohorts. The improved ability to discriminate patients with different survival probability when using TNM7 was greater in the LTHT cohort. The current findings indicated that the discriminatory ability of the TNM stage groups may depend on the baseline survival characteristics of the patient cohort.
背景
本研究旨在探讨第七版美国癌症联合委员会/国际抗癌联盟 TNM 分期（TNM7）与第六版 TNM 分期（TNM6）相比，在无论起源国如何的胃癌患者中是否具有更好的区分能力。
方法
本研究共纳入了来自日本神奈川癌症中心医院（横滨）（KCCH）的 538 例和英国利兹教学医院国家卫生服务信托（利兹）（LTHT）的 519 例接受胃癌手术的患者。采用总生存进行统计分析。采用疾病分期作为连续变量来评估 TNM 分期组的区分能力，估计危险比（HR）。比较 TNM6 和 TNM7 分期组的 HR 估计值（logHRs）。
结果
在 KCCH 队列中，与 LTHT 队列相比，TNM6 和 TNM7 之间分别有 82 例（15%）患者分期上调和 26 例（5%）患者分期下调，而分别有 253 例（49%）和 53 例（10%）患者分期上调和下调。在 KCCH 队列中，TNM6 和 TNM7 中每增加 1 期的 logHRs 分别为 1.06 和 1.16，在 LTHT 队列中分别为 0.57 和 0.79。TNM6 和 TNM7 之间的 logHRs 差异在每个队列中均有统计学意义（KCCH：logHR，0.11；P=0.024；LTHT：logHR，0.21；P=0.0002），且在两个队列之间也存在差异。
结论
与 TNM6 相比，TNM7 在两个队列中均具有更好的区分能力。在 LTHT 队列中，使用 TNM7 区分生存概率不同的患者的能力提高更大。目前的研究结果表明，TNM 分期组的区分能力可能取决于患者队列的基线生存特征。
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