Cancer Center, Sun Yat-sen University State Key Laboratory of Oncology in South China, Guangzhou, China.
J Thorac Cardiovasc Surg. 2013 Jul;146(1):45-51. doi: 10.1016/j.jtcvs.2013.01.034. Epub 2013 Mar 13.
The TNM staging system for esophageal cancer in the seventh edition of the AJCC Cancer Staging Manual incorporates tumor grade and location for staging pT2-3N0M0 esophageal squamous cell carcinoma. Patients with pT2N0M0, classified as stage IIA according to the sixth edition of the AJCC Cancer Staging Manual, can now be classified as stage IB, IIA, or IIB. We discuss whether these changes lead to a better prediction of the prognosis of these patients and aimed to find out other factors to forecast patient prognosis.
We retrospectively analyzed 317 patients with postoperative pathologic stage T2N0M0 who underwent esophagectomy between 1990 and 2005 at Sun Yat-sen University Cancer Center. We performed univariate and multivariate analyses to identify prognostic factors for survival and used the Kaplan-Meier method to demonstrate the prognostic efficacy of each prognostic factor, including tumor grade and location.
The 5-year overall survival was 57%, with a median survival of 84.5 months (6.94 years). Univariate analysis indicated that age, alcohol consumption, and tumor grade were associated with survival. Multivariate Cox proportional hazard regression analysis revealed that alcohol consumption and tumor grade were independent prognostic factors. Survival analysis using the Kaplan-Meier method demonstrated age, cigarette smoking, alcohol consumption, tumor grade, and location as prognostic factors.
For pT2N0M0 esophageal squamous cell carcinoma, the seventh edition of the AJCC Cancer Staging Manual does not provide a more distinguishable prediction of prognosis compared with the sixth edition. Tumor grade is an independent prognostic factor in patients with pT2N0M0 esophageal squamous cell carcinoma, whereas tumor location is not. Furthermore, alcohol consumption is an independent prognostic factor that may imply a worse prognosis.
第七版 AJCC 癌症分期手册中的食管癌 TNM 分期系统纳入了肿瘤分级和位置，用于分期 pT2-3N0M0 食管鳞状细胞癌。根据第六版 AJCC 癌症分期手册，pT2N0M0 患者被归类为 IIA 期，现在可以归类为 IB、IIA 或 IIB 期。我们讨论了这些变化是否导致对这些患者预后的更好预测，并旨在寻找其他因素来预测患者的预后。
我们回顾性分析了中山大学肿瘤防治中心 1990 年至 2005 年间接受食管癌切除术的 317 例术后病理分期为 T2N0M0 的患者。我们进行了单因素和多因素分析，以确定生存的预后因素，并使用 Kaplan-Meier 方法展示每个预后因素的预后效果，包括肿瘤分级和位置。
5 年总生存率为 57%，中位生存时间为 84.5 个月（6.94 年）。单因素分析表明，年龄、饮酒和肿瘤分级与生存有关。多因素 Cox 比例风险回归分析显示，饮酒和肿瘤分级是独立的预后因素。Kaplan-Meier 方法的生存分析表明，年龄、吸烟、饮酒、肿瘤分级和位置是预后因素。
对于 pT2N0M0 食管鳞状细胞癌，第七版 AJCC 癌症分期手册并没有比第六版提供更具区分度的预后预测。肿瘤分级是 pT2N0M0 食管鳞状细胞癌患者的独立预后因素，而肿瘤位置不是。此外，饮酒是一个独立的预后因素，可能意味着预后更差。
