Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Clin Genitourin Cancer. 2017 Dec;15(6):e1095-e1106. doi: 10.1016/j.clgc.2017.07.025. Epub 2017 Aug 3.
To validate the prognostic value of the new American Joint Committee on Cancer (AJCC) staging system (eighth edition) among different staging contexts (clinical vs. pathologic).
Surveillance, Epidemiology, and End Results (SEER) database (2010-2014) was accessed through SEER*Stat program and both AJCC seventh and eighth edition stages were assigned for each patient. Overall and cancer-specific survival analyses according to both editions were conducted through Kaplan-Meier analysis. Concordance index (c-index) was assessed for each edition.
A total of 7074 patients with pathologically staged and 26,698 with clinically staged urinary bladder carcinoma were identified in the period from 2010 to 2014. Among patients with pathologically staged disease without neoadjuvant treatment, P values for all pairwise comparisons among different stages (according to AJCC seventh and eighth systems) were significant for both overall and cancer-specific survivals (< .01). Moreover, within the same cohort, c-index (using death from urinary bladder cancer as the dependent variable) for AJCC seventh system was 0.714 (SE 0.008; 95% CI, 0.699-0.729); whereas the c-index for the AJCC eighth system was 0.718 (SE 0.008; 95% CI, 0.702-0.733). Likewise, among patients with clinically staged disease, P values for all pairwise comparisons among different AJCC eighth stages were significant for overall survival (< .05) except for stage IIIA versus stage IIIB; whereas P values for all pairwise comparisons among different AJCC eighth stages were significant for cancer-specific survival (P < .05).
This analysis supports the prognostic relevance of the added substages described within AJCC eighth edition stages III and IV for clinically staged and pathologically staged disease without neoadjuvant treatment.
验证新的美国癌症联合委员会（AJCC）分期系统（第八版）在不同分期环境（临床与病理）中的预后价值。
通过 SEER*Stat 程序访问监测、流行病学和最终结果（SEER）数据库（2010-2014 年），并为每位患者分配 AJCC 第七和第八版分期。通过 Kaplan-Meier 分析对两个版本的总生存和癌症特异性生存进行分析。评估每个版本的一致性指数（c-index）。
在 2010 年至 2014 年期间，共确定了 7074 例经病理分期和 26698 例经临床分期的膀胱癌患者。在未经新辅助治疗的病理分期疾病患者中，AJCC 第七和第八系统不同分期之间的所有两两比较的 P 值均为总生存和癌症特异性生存（<0.01）。此外，在同一队列中，AJCC 第七版系统的 c-index（以膀胱癌死亡为因变量）为 0.714（SE 0.008；95%CI，0.699-0.729）；而 AJCC 第八版系统的 c-index 为 0.718（SE 0.008；95%CI，0.702-0.733）。同样，在临床分期疾病患者中，除 IIIA 期与 IIIB 期外，AJCC 第八版不同分期之间的所有两两比较的 P 值均为总生存（<0.05）；而 AJCC 第八版不同分期之间的所有两两比较的 P 值均为癌症特异性生存（P<0.05）。
这项分析支持 AJCC 第八版中 III 期和 IV 期描述的附加亚期对未经新辅助治疗的临床分期和病理分期疾病的预后相关性。
