Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, China.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Endoscopy, Peking University Cancer Hospital and Institute, Beijing, China.
Gastric Cancer. 2018 Jul;21(4):643-652. doi: 10.1007/s10120-017-0779-5. Epub 2017 Nov 22.
We investigated the superiority of the 8th edition of the tumor-node-metastasis (TNM) system for patients in China with gastric cancer.
The survival outcomes of 1663 patients with gastric cancer undergoing radical resection were analyzed.
In the 8th edition system, homogeneous 5-year survival rates among different pathological TNM (pTNM) categories belonging to the same stage were observed. However, in the 7th edition system, the differences of 5-year survival rate among pTNM categories belonging to the same stage were observed in stages IIB (P = 0.010), IIIB (P = 0.004), and IIIC (P < 0.001). For patients in the pT1-3 (P < 0.001) and pT4a (P < 0.001) categories, there were significant differences in survival between patients in the pN3a and pN3b categories. Furthermore, partial cases (pT4bN0M0/T4aN2M0) of stage IIIB were downstaged to stage IIIA in the 8th edition system, and the 5-year survival rate of these patients was significantly better than that of patients in stage IIIB in the 8th edition system. Similarly, the 5-year survival rate of patients in p4bN2M0/T4aN3aM0 downstaged from stage IIIC to IIIB was significantly better than that of patients in stage IIIC. Compared with the 7th edition system, the 8th edition system had a higher likelihood ratio and linear trend chi-squared score and a smaller Akaike information criteria value.
The 8th edition system is superior to the 7th edition system in terms of homogeneity, discriminatory ability, and monotonicity of gradients for Chinese patients with gastric cancer.
我们研究了第 8 版肿瘤-淋巴结-转移（TNM）系统在我国胃癌患者中的优越性。
分析了 1663 例接受根治性切除术的胃癌患者的生存结果。
在第 8 版系统中，属于同一期的不同病理 TNM（pTNM）类别具有相似的 5 年生存率。然而，在第 7 版系统中，属于同一期的 pTNM 类别的 5 年生存率存在差异，在 IIB 期（P=0.010）、IIIB 期（P=0.004）和 IIIC 期（P<0.001）。对于 pT1-3（P<0.001）和 pT4a（P<0.001）类别的患者，pN3a 和 pN3b 类别的患者在生存方面存在显著差异。此外，部分 IIIB 期患者（pT4bN0M0/T4aN2M0）在第 8 版系统中被降期至 IIIA 期，这些患者的 5 年生存率明显优于第 8 版系统中 IIIB 期患者。同样，p4bN2M0/T4aN3aM0 类别的患者从 IIIC 期降期至 IIIB 期后，其 5 年生存率明显优于 IIIC 期患者。与第 7 版系统相比，第 8 版系统的似然比、线性趋势卡方得分更高，Akaike 信息准则值更小。
第 8 版系统在我国胃癌患者中具有更好的同质性、区分能力和梯度单调性。
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