Rice Thomas W, Patil Deepa T, Blackstone Eugene H
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Ann Cardiothorac Surg. 2017 Mar;6(2):119-130. doi: 10.21037/acs.2017.03.14.
The 8th edition of the American Joint Committee on Cancer (AJCC) staging of epithelial cancers of the esophagus and esophagogastric junction (EGJ) presents separate classifications for clinical (cTNM), pathologic (pTNM), and postneoadjuvant (ypTNM) stage groups. Histopathologic cell type markedly affects survival of clinically and pathologically staged patients, requiring separate groupings for each cell type, but ypTNM groupings are identical for both cell types. Clinical categories, typically obtained by imaging with minimal histologic information, are limited by resolution of each method. Strengths and shortcomings of clinical staging methods should be recognized. Complementary cytology or histopathology findings may augment imaging and aid initial treatment decision-making. However, prognostication using clinical stage groups remains coarse and inaccurate compared with pTNM. Pathologic staging is losing its relevance for advanced-stage cancer as neoadjuvant therapy replaces esophagectomy alone. However, it remains relevant for early-stage cancers and as a staging and survival reference point. Although pathologic stage could facilitate decision-making, its use to direct postoperative adjuvant therapy awaits more effective treatment. Prognostication using pathologic stage groups is the most refined of all classifications. Postneoadjuvant staging (ypTNM) is introduced by the AJCC but not adopted by the Union for International Cancer Control (UICC). Drivers of this addition include absence of equivalent pathologic (pTNM) categories for categories peculiar to the postneoadjuvant state (ypT0N0-3M0 and ypTisN0-3M0), dissimilar stage group compositions, and markedly different survival profiles. Thus, prognostication is specific for patients undergoing neoadjuvant therapy. The role of ypTNM classification in additional treatment decision-making is currently limited. Precision cancer care advances are necessary for this information to be clinically useful.
美国癌症联合委员会（AJCC）第八版食管癌和食管胃交界（EGJ）上皮癌分期对临床（cTNM）、病理（pTNM）和新辅助治疗后（ypTNM）分期组给出了单独的分类。组织病理学细胞类型显著影响临床和病理分期患者的生存率，每种细胞类型需要单独分组，但两种细胞类型的ypTNM分组相同。临床分类通常通过影像学检查获得，组织学信息极少，受每种方法分辨率的限制。应认识到临床分期方法的优缺点。补充的细胞学或组织病理学结果可能增强影像学检查效果并有助于初始治疗决策。然而，与pTNM相比，使用临床分期组进行预后评估仍然粗略且不准确。随着新辅助治疗取代单纯食管切除术，病理分期对晚期癌症的相关性正在降低。然而，它对早期癌症仍然具有相关性，并且作为分期和生存参考点。虽然病理分期有助于决策，但其用于指导术后辅助治疗尚有待更有效的治疗方法。使用病理分期组进行预后评估是所有分类中最精确的。AJCC引入了新辅助治疗后分期（ypTNM），但国际癌症控制联盟（UICC）未采用。增加这一分期的原因包括新辅助治疗后状态特有的类别（ypT0N0 - 3M0和ypTisN0 - 3M0）缺乏等效的病理（pTNM）类别、分期组构成不同以及生存概况明显不同。因此，预后评估对于接受新辅助治疗的患者具有特异性。ypTNM分类在额外治疗决策中的作用目前有限。要使这些信息具有临床实用性，精准癌症治疗的进展是必要的。
