Hou Xue, Gu Yang-Kui, Liu Xue-Wen, Fu Jian-Hua, Wang Xin, Zhang Lan-Jun, Luo Rong-Zhen, Lin Peng, Yang Hao-Xian
Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.
Ann Surg Oncol. 2015 Mar;22(3):1008-14. doi: 10.1245/s10434-014-4067-x. Epub 2014 Sep 9.
The current American Joint Committee on Cancer staging system considers tumor cell differentiation grade to be a factor in the staging of esophageal squamous cell carcinoma (ESCC) in pathologic T0-3N0M0 cases. However, more data are essential to test its efficacy. We sought to investigate the tumor-node-metastasis categories for which tumor cell grade might affect overall survival in Chinese patients.
We conducted a retrospective review of 1,220 patients with ESCC who underwent complete resection between December 1996 and December 2008. Survival was calculated by the Kaplan-Meier method, and the log-rank test was used to assess differences in survival between groups. Subgroup analyses and the Cox proportional hazards model were used to further determine the effect of tumor cell grade on overall survival.
The 5-year survival rates for the G1, G2, and G3 groups of pathologic T2N0M0 ESCC cases were 80.1, 61.9, and 47.4%, respectively (p = 0.015), and these rates in the pathologic T3N0M0 ESCC cases were 66.7, 61.7, and 41.2%, respectively (p = 0.020). However, the differences in the survival of the different tumor cell grade groups of the pathologic T1N0M0 (p = 0.198) and the node positive categories (p = 0.063) were not statistically significant. Multivariate Cox regression analysis confirmed that tumor cell grade independently affected the overall survival of patients with pathologic T2-3N0M0 ESCC.
The staging of ESCC in the Chinese population should be simplified by omitting tumor cell grade as a variable in patients with pathologic T1N0M0 disease. More data are needed to verify our results.
当前美国癌症联合委员会分期系统认为，在病理分期为T0 - 3N0M0的食管鳞状细胞癌（ESCC）病例中，肿瘤细胞分化程度是分期的一个因素。然而，需要更多数据来检验其有效性。我们试图研究在中国患者中，肿瘤细胞分级可能影响总生存的肿瘤 - 淋巴结 - 转移分类。
我们对1996年12月至2008年12月间接受根治性切除的1220例ESCC患者进行了回顾性研究。采用Kaplan - Meier法计算生存率，并用对数秩检验评估组间生存差异。亚组分析和Cox比例风险模型用于进一步确定肿瘤细胞分级对总生存的影响。
病理分期为T2N0M0的ESCC病例中，G1、G2和G3组的5年生存率分别为80.1%、61.9%和47.4%（p = 0.015）；病理分期为T3N0M0的ESCC病例中，这三组的5年生存率分别为66.7%、61.7%和41.2%（p = 0.020）。然而，病理分期为T1N0M0（p = 0.198）和淋巴结阳性分类（p = 0.063）的不同肿瘤细胞分级组间生存差异无统计学意义。多因素Cox回归分析证实，肿瘤细胞分级独立影响病理分期为T2 - 3N0M0的ESCC患者的总生存。
对于病理分期为T1N0M0疾病的患者，中国人群ESCC分期应简化，省略肿瘤细胞分级这一变量。需要更多数据来验证我们的结果。
