Henson Donald E, Hueman Matthew T, Chen Dechang, Patel Jigar A, Wang Huan, Schwartz Arnold M
Division of Epidemiology and Biostatistics, Department of Preventive Medicine and Biostatistics, The Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
Surgical Oncology, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Bethesda, Maryland 20889, USA.
J Gastrointest Oncol. 2017 Feb;8(1):12-19. doi: 10.21037/jgo.2016.11.10.
To visualize the anatomy as revealed by dendrograms of the tumor, lymph node, and metastasis (TNM) staging system for colon cancer and compare it with the Dukes' system.
A hierarchical clustering algorithm generated tree-structured dendrograms that stratified patients according to survival only. The dendrograms were constructed with the same prognostic variables used for the TNM. Because combinations of prognostic factors were stratified only on survival, additional factors of any number and type could be integrated into the TNM without changing the TNM categories.
The algorithm provided a step-by-step visualization of the TNM and the Dukes' system for colon cancer. Dendrograms and associated 5-year survival rates were generated for the T category only, the N category only, the T, N combination, and combinations of the T, N, and M, and the T, N, M with histological grade. Dendrograms revealed visual differences between the structure of TNM and the Dukes' system of staging. Dendrograms also revealed how variations in prognostic factors changed survival. By cutting dendrograms along their dissimilarity axis, multiple prognostic subgroups could be created for colon cancer that may reflect outcomes that are more accurate to estimate.
Dendrograms provide a new way to view cancer patient staging. They reveal a visual step-by-step hierarchical relationship between survival rates and combinations of prognostic variables. The dendrograms also revealed fundamental differences between the TNM and the Dukes system of staging. By stratifying on survival only, additional factors including molecular factors can be added to the TNM, because it classifies patients according to survival rates only and not according to pre-set rules of prognostic factors and stage groups. The clinical implications of stratifying only survival are discussed.
可视化结肠癌肿瘤、淋巴结和转移（TNM）分期系统树形图所揭示的解剖结构，并将其与杜克系统进行比较。
一种层次聚类算法生成了仅根据生存率对患者进行分层的树形结构树形图。这些树形图是用与TNM相同的预后变量构建的。由于预后因素的组合仅根据生存率进行分层，所以任意数量和类型的其他因素都可以整合到TNM中而不改变TNM类别。
该算法为结肠癌的TNM和杜克系统提供了逐步可视化。仅针对T类别、仅针对N类别、T、N组合以及T、N、M组合以及带有组织学分级的T、N、M生成了树形图和相关的5年生存率。树形图揭示了TNM结构与杜克分期系统之间的视觉差异。树形图还揭示了预后因素的变化如何改变生存率。通过沿其相异轴切割树形图，可以为结肠癌创建多个预后亚组，这些亚组可能反映出更准确估计的结果。
树形图为查看癌症患者分期提供了一种新方法。它们揭示了生存率与预后变量组合之间逐步的视觉层次关系。树形图还揭示了TNM与杜克分期系统之间的根本差异。由于仅根据生存率对患者进行分类，而不是根据预后因素和分期组的预设规则，所以可以将包括分子因素在内的其他因素添加到TNM中。讨论了仅根据生存率进行分层的临床意义。
