Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Lotfy Elsayed Street, Cairo, 11566, Egypt.
Clin Transl Oncol. 2018 Jun;20(6):794-800. doi: 10.1007/s12094-017-1781-4. Epub 2017 Oct 30.
The current study tried to evaluate the prognostic value of a modified staging system compared to the American Joint Committee on Cancer (AJCC) staging system for patients with colon cancer.
Surveillance, epidemiology and end results (SEER) database (2004-2014) was queried through SEER*Stat program and AJCC 7th stages were constructed. Through recursive partitioning analysis and subsequent decision tree formation, suggested new stages were formulated based on T and N descriptors. Overall survival analyses were performed through Kaplan-Meier analysis. The cancer-specific Cox regression hazard (adjusted for age, gender, sub-site, grade, race and surgery) was calculated and pair wise comparisons of hazard ratios were conducted.
A total of 159,683 non-metastatic patients with colon cancer were recruited in the analysis. Pair wise hazard ratio comparisons among different AJCC 7th stages were conducted and all comparisons were significant (P < 0.0001). However, it should be noted that the adjusted risk of death among stage IIC patients was higher than stage IIIA and IIIB. Pair wise hazard ratio comparisons among different modified system stages were also conducted and all comparisons were significant (P < 0.0001). The outcomes of survival analysis were the same regardless of the number of examined lymph nodes (< 12 vs. ≥ 12). Concordance index (using death from colon cancer as the dependent variable) for AJCC 6th staging system was 0.704 (SE 0.002; 95% CI 0.701-0.708); for AJCC 7th staging system was 0.708 (SE 0.002; 95% CI 0.704-0.711); for Dukes staging system was 0.670 (SE 0.002; 95% CI 0.666-0.674); and for modified staging system was 0.712 (SE 0.002; 95% CI 0.709-0.716).
The proposed modified staging system provided an improved prognostication for colon cancer patients (particularly for stage II/III disease) compared to AJCC staging system. Further external validation of the proposed staging system is needed before adoption into routine practice.
本研究旨在评估改良分期系统与美国癌症联合委员会（AJCC）分期系统相比对结肠癌患者的预后价值。
通过 SEER*Stat 程序检索监测、流行病学和最终结果（SEER）数据库（2004-2014 年），并构建 AJCC 第 7 版分期。通过递归分区分析和随后的决策树形成，根据 T 和 N 描述符制定了新的分期。通过 Kaplan-Meier 分析进行总生存分析。通过癌症特异性 Cox 回归风险（调整年龄、性别、部位、分级、种族和手术）进行计算，并进行风险比的两两比较。
共纳入 159683 例非转移性结肠癌患者。对不同 AJCC 第 7 版分期进行风险比的两两比较，所有比较均有统计学意义（P<0.0001）。然而，值得注意的是，IIIC 期患者的死亡调整风险高于 IIIA 期和 IIIB 期。对不同改良系统分期进行风险比的两两比较，所有比较均有统计学意义（P<0.0001）。无论检查的淋巴结数量如何（<12 vs.≥12），生存分析的结果均相同。AJCC 第 6 版分期系统的一致性指数（以结肠癌死亡为因变量）为 0.704（SE 0.002；95%CI 0.701-0.708）；AJCC 第 7 版分期系统为 0.708（SE 0.002；95%CI 0.704-0.711）；Dukes 分期系统为 0.670（SE 0.002；95%CI 0.666-0.674）；改良分期系统为 0.712（SE 0.002；95%CI 0.709-0.716）。
与 AJCC 分期系统相比，改良分期系统为结肠癌患者（特别是 II/III 期疾病患者）提供了更好的预后预测。在常规实践中采用之前，需要对该分期系统进行进一步的外部验证。
