Röcken C, Behrens H-M
Department of Pathology, Christian-Albrechts-University, Kiel, Germany.
Department of Pathology, Christian-Albrechts-University, Kiel, Germany.
Eur J Cancer. 2015 Mar;51(5):577-86. doi: 10.1016/j.ejca.2015.01.055. Epub 2015 Feb 11.
We investigated the effect of the new tumour-, node-, metastasis- (TNM) classification on predicting and discriminating gastric cancer patient prognosis using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program.
From the SEER-database we retrieved gastric cancer patients with a primary adenocarcinoma, of Caucasian or Asian ethnicity and without distant metastases (M0). The pTNM-stage was determined according to the 7th edition of the union internationale contre le cancer (UICC) guidelines.
Spanning the period 2004-2010, 6136 patients fulfilled all inclusion criteria including 3424 (55.8%) men, 2712 (44.2%) women, 4629 (75.4%) Caucasian and 1507 (24.6%) Asian patients. 1524 (24.8%) patients underwent total gastrectomy and 4612 (75.2%) non-total gastrectomy. Only in 41.2% of the patients were >15 lymph nodes resected. 1857 (31.0%) patients received radiotherapy. Patient survival depended on ethnicity, type of surgery and radiotherapy. The discriminating value of the UICC-stage grouping could not be validated for Caucasian patients with >15 lymph nodes resected and who had not received radiotherapy: stage groups IIB, IIIA, IIIB and IIIC showed substantial overlap in survival ranges. In addition, the tumour specific survival of the different T-/N-combinations was significantly different in stage groups IIIB and IIIC, respectively.
Our retrospective analysis of the SEER-database does not validate the discriminating value of stage grouping of the 7th edition of the UICC-stage grouping. A revision should be considered and more reliable prognostic biomarkers are urgently needed.
我们利用美国国立癌症研究所的监测、流行病学和最终结果（SEER）计划，研究了新的肿瘤-淋巴结-转移（TNM）分类对预测和区分胃癌患者预后的影响。
我们从SEER数据库中检索出原发性腺癌、白种人或亚洲人种且无远处转移（M0）的胃癌患者。根据国际抗癌联盟（UICC）第7版指南确定pTNM分期。
在2004年至2010年期间，6136例患者符合所有纳入标准，其中男性3424例（55.8%），女性2712例（44.2%），白种人4629例（75.4%），亚洲患者1507例（24.6%）。1524例（24.8%）患者接受了全胃切除术，4612例（75.2%）患者接受了非全胃切除术。仅41.2%的患者切除了超过15个淋巴结。1857例（31.0%）患者接受了放疗。患者的生存情况取决于种族、手术类型和放疗。对于切除了超过15个淋巴结且未接受放疗的白种人患者，UICC分期分组的区分价值无法得到验证：IIB、IIIA、IIIB和IIIC期组在生存范围上有很大重叠。此外，IIIB期和IIIC期组中不同T/N组合的肿瘤特异性生存情况分别有显著差异。
我们对SEER数据库的回顾性分析未验证UICC第7版分期分组的区分价值。应考虑进行修订，并且迫切需要更可靠的预后生物标志物。
