为胃癌的第八版美国癌症联合委员会分期配备 15 个最小淋巴结：使用递归分区分析的基于人群的研究。
Equipping the 8th Edition American Joint Committee on Cancer Staging for Gastric Cancer with the 15-Node Minimum: a Population-Based Study Using Recursive Partitioning Analysis.
机构信息
Department of Gastric Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dong Feng Road East, Guangzhou, 510060, China.
Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China.
出版信息
J Gastrointest Surg. 2017 Oct;21(10):1591-1598. doi: 10.1007/s11605-017-3504-0. Epub 2017 Jul 27.
BAKCGROUND
The recently proposed 8th American Joint Committee on Cancer (AJCC) staging for gastric cancer (GC) did not include the evaluated lymph node (ELN) count as a prognostic indicator. In this study, we performed recursive partitioning analysis (RPA) to objectively combine the 15-ELN threshold and 8th AJCC stage to refine the staging for GC.
METHODS
We analyzed 19,018 patients with non-metastatic GC from the Surveillance, Epidemiology, and End Results database. The dataset was randomly divided into training and validation sets.
RESULTS
For each 8th AJCC stage, survival was significantly better for patients with ≥15 ELNs versus those with <15 ELNs (P < 0.001 for all). RPA divided non-metastatic GC into seven stages: RPA-IA (8th AJCC IA with ≥15 ELNs), RPA-IB (IA with <15 ELNs and IB/IIA with ≥15 ELNs), RPA-IIA (IB with <15 ELNs and IIB with ≥15 ELNs), RPA-IIB (IIA with <15 ELNs and IIIA with ≥15 ELNs), RPA-IIIA (IIB with <15 ELNs), RPA-IIIB (IIIA with <15 ELNs and IIIB ≥15 ELNs), and RPA-IIIC (IIIB with <15 ELNs and IIIC). The corresponding 5-year survival rates were 84.1, 70.3, 52.8, 41.4, 32.9, 21.7, and 10.2%, respectively (P < 0.001 for all pairwise comparisons). The RPA staging outperformed the 8th AJCC staging in terms of discrimination and homogeneity among the SEER training and validation sets, as well as an independent Chinese cohort.
CONCLUSION
By equipping the 8th AJCC stage with the 15-ELN threshold, the proposed RPA staging is superior to the 8th AJCC staging without overcomplicating.
背景
最近提出的第八版美国癌症联合委员会（AJCC）胃癌分期并未将评估的淋巴结（ELN）计数作为预后指标。本研究通过递归分区分析（RPA）客观地将 15-ELN 阈值和第八版 AJCC 分期相结合，以细化胃癌分期。
方法
我们分析了来自监测、流行病学和最终结果（SEER）数据库的 19018 例非转移性胃癌患者。数据集随机分为训练集和验证集。
结果
对于每个第八版 AJCC 分期，ELN 计数≥15 的患者的生存情况均显著优于 ELN 计数<15 的患者（所有 P 值均<0.001）。RPA 将非转移性胃癌分为七个分期：RPA-IA（第八版 AJCC IA 且 ELN 计数≥15）、RPA-IB（IA 且 ELN 计数<15，IB/IIA 且 ELN 计数≥15）、RPA-IIA（IB 且 ELN 计数<15，IIB 且 ELN 计数≥15）、RPA-IIB（IIA 且 ELN 计数<15，IIIA 且 ELN 计数≥15）、RPA-IIIA（IIB 且 ELN 计数<15）、RPA-IIIB（IIIA 且 ELN 计数<15，IIIB 且 ELN 计数≥15）和 RPA-IIIC（IIIB 且 ELN 计数<15，IIIC 且 ELN 计数≥15）。相应的 5 年生存率分别为 84.1%、70.3%、52.8%、41.4%、32.9%、21.7%和 10.2%（所有 P 值均<0.001）。RPA 分期在 SEER 训练集和验证集以及独立的中国队列中的鉴别力和同质性方面均优于第八版 AJCC 分期，且不会过于复杂。
结论
通过为第八版 AJCC 分期配备 15-ELN 阈值，所提出的 RPA 分期优于没有此改进的第八版 AJCC 分期。
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