Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Cancer Med. 2017 Oct;6(10):2179-2187. doi: 10.1002/cam4.1118. Epub 2017 Sep 14.
The 8th edition of the TNM was released in 2016 and included major revisions, especially for stage III. We aimed to compare the prognostic value of the 7th and 8th editions of the AJCC TNM classification for stage III gastric cancer. Clinical data from 1557 patients operated on for stage III gastric cancer according to the 7th edition between 2007 and 2014 were analyzed and compared using the 7th and 8th TNM classifications. A proposed staging system was established, and the three systems were compared in terms of prognostic performance. The stage shifted for 669 (42.96%) patients. It shifted from IIIA to IIIB (one patient, 0.06%), IIIB to IIIA (230 patients, 14.8%), IIIB to IIIC (94 patients, 6.0%), and IIIC to IIIB (344 patients, 22.1%). However, the new AJCC subgroupings did not prove distinctive for survival levels between T3N3aM0 (stage IIIB) and T3N3bM0 (stage IIIC) or between T4aN3aM0 (stage IIIB) and T4aN3bM0 (stage IIIC) when <30 lymph nodes (LNs) were resected. The performance of the 8th edition (c-index, 0.614; 95% confidence interval [CI], 0.596-0.633) revealed no relevant improvement compared to the 7th edition (c-index, 0.624; 95% CI, 0.605-0.643). The proposed staging system generated the best prognostic stratification. The 8th TNM edition may not provide better accuracy in predicting the prognosis of stage III gastric cancer. The proposed staging system, comprised of a combination of the number of LNs harvested and the 7th and 8th AJCC classifications, may improve predictive capacities for stage III gastric cancer.
第八版 TNM 于 2016 年发布，其中包含了重大修订，特别是对于 III 期。我们旨在比较第七版和第八版 AJCC TNM 分期系统在 III 期胃癌中的预后价值。分析了 2007 年至 2014 年间根据第七版 AJCC 分期标准接受 III 期胃癌手术的 1557 例患者的临床资料，并使用第七版和第八版 TNM 分类进行比较。建立了一个分期系统，并比较了这三个系统在预后性能方面的差异。669 例（42.96%）患者的分期发生了变化。从 IIIA 期变为 IIIB 期（1 例，0.06%），从 IIIB 期变为 IIIA 期（230 例，14.8%），从 IIIB 期变为 IIIC 期（94 例，6.0%），从 IIIC 期变为 IIIB 期（344 例，22.1%）。然而，当<30 个淋巴结（LN）被切除时，新的 AJCC 亚组对于 T3N3aM0（III 期）和 T3N3bM0（IIIC 期）或 T4aN3aM0（III 期）和 T4aN3bM0（IIIC 期）之间的生存水平没有明显的区别。与第七版（c-index，0.624；95%置信区间[CI]，0.605-0.643）相比，第八版（c-index，0.614；95%CI，0.596-0.633）的表现没有明显的改善。提出的分期系统产生了最佳的预后分层。第八版 TNM 可能无法提供更准确的预测 III 期胃癌的预后。由 LN 数量和第七版和第八版 AJCC 分类组成的提出的分期系统可能会提高 III 期胃癌的预测能力。
