Division of Gastric Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumichou, Suntougun, Shizuoka, 411-0934, Japan.
Gastric Cancer. 2017 May;20(3):448-456. doi: 10.1007/s10120-016-0637-x. Epub 2016 Sep 1.
Preoperative clinical staging of gastric cancer is used to determine therapeutic strategies. However, the impact of the clinical stage on survival has not been completely investigated, although the relationship between pathologic staging and survival outcome has been reported. The aim of the present study was to clarify the predictability of patient survival based on clinical staging and to evaluate the usefulness of staging as an indicator for selecting the treatment modality.
A total of 3033 patients who underwent surgery for gastric cancer were included. A survival analysis was conducted based on the seventh edition of the tumor-node-metastasis (TNM) clinical staging system of the American Joint Committee on Cancer. The predictive ability of the TNM clinical stage for survival was evaluated by Harrell's C-index, a measure of the separation of survival distributions.
The cumulative 5-year survival rates according to the clinical stage were 94.3 % (IA), 84.7 % (IB), 71.7 % (IIA), 56.1 % (IIB), 55.7 % (IIIA), 42.3 % (IIIB), 22.8 % (IIIC), and 9.1 % (IV). Although no significant difference was observed between clinical stages IIB and IIIA (p = 0.865), significant differences existed between all other clinical stages (p < 0.001). Harrell's C-index applied to these results was 0.825 (95 % confidence interval 0.819-0.831).
The seventh edition of the TNM clinical staging system has a strong prognostic ability with a satisfactory C-index and should be considered valuable for selecting therapeutic strategies for the treatment of gastric cancer.
胃癌的术前临床分期用于确定治疗策略。然而，尽管已经报道了病理分期与生存结果之间的关系，但临床分期对生存的影响尚未完全研究。本研究旨在阐明基于临床分期预测患者生存的能力，并评估分期作为选择治疗方式的指标的有用性。
共纳入 3033 例接受胃癌手术的患者。根据美国癌症联合委员会的第七版肿瘤-淋巴结-转移（TNM）临床分期系统进行生存分析。通过 Harrell 的 C 指数评估 TNM 临床分期对生存的预测能力，该指数用于衡量生存分布的分离情况。
根据临床分期，患者的 5 年累积生存率分别为 94.3%（IA）、84.7%（IB）、71.7%（IIA）、56.1%（IIB）、55.7%（IIIA）、42.3%（IIIB）、22.8%（IIIC）和 9.1%（IV）。尽管临床分期 IIB 和 IIIA 之间无显著差异（p=0.865），但所有其他临床分期之间均存在显著差异（p<0.001）。应用于这些结果的 Harrell 的 C 指数为 0.825（95%置信区间 0.819-0.831）。
第七版 TNM 临床分期系统具有较强的预后能力，C 指数令人满意，应被认为对选择治疗胃癌的治疗策略有价值。
