评估第 8 版 AJCC 病理分期与临床分期系统在胰腺腺癌中的应用：是否需要重新审视这一传统观点？
Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma?
机构信息
Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
出版信息
Hepatobiliary Pancreat Dis Int. 2018 Feb;17(1):64-69. doi: 10.1016/j.hbpd.2018.01.014. Epub 2018 Jan 31.
BACKGROUND
The 8th edition of the American Joint Committee on Cancer (AJCC) staging system for pancreatic exocrine adenocarcinoma has been released. The current study seeks to assess the 7th and 8th editions among patients registered within the surveillance, epidemiology and end results (SEER) database.
METHODS
SEER database (2010-2013) has been accessed through SEER*Stat program and AJCC 8th edition stages were reconstructed utilizing the collaborative stage descriptions. Kaplan-Meier analysis of overall survival and pancreatic cancer-specific survival analyses (according to both 7th and 8th editions and according to whether pathological or clinical staging were conducted) has been performed. Multivariate analysis of factors affecting pancreatic cancer-specific survival was also conducted through a Cox proportional hazard model.
RESULTS
A total of 18 948 patients with pancreatic adenocarcinoma were identified in the period from 2010-2013. Pancreatic cancer-specific survival among pathologically staged patients and according to the 8th edition showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between stage IA and stage IB (P = 0.307) and the comparison between stage IB and stage IIA (P = 0.116). Moreover, P value for stage IA vs IIA was 0.014; while pancreatic cancer-specific survival according to the 7th edition among pathologically staged patients showed significant differences for all pair wise comparisons among different stages (P < 0.0001) except for the comparison between IA and IB (P = 0.072), the comparison between stage IIA and stage IIB (P = 0.065), the comparison between stage IIA and stage III (P = 0.059) and the comparison between IIB and III (P = 0.595). Among clinically staged patients (i.e. those who did not undergo initial radical surgery), the prognostic performance of both 7th and 8th stages for both overall survival and pancreatic cancer-specific survival was limited.
CONCLUSION
There is clearly a need to have two staging systems for pancreatic adenocarcinoma: pathological and clinical staging systems.
背景
美国癌症联合委员会（AJCC）第 8 版胰腺外分泌腺癌分期系统已经发布。本研究旨在评估在监测、流行病学和最终结果（SEER）数据库中登记的患者中使用第 7 版和第 8 版分期系统的情况。
方法
通过 SEER*Stat 程序访问 SEER 数据库（2010-2013 年），并利用协作分期描述重建 AJCC 第 8 版分期。对总生存率和胰腺癌特异性生存率（根据第 7 版和第 8 版以及是否进行病理或临床分期）进行 Kaplan-Meier 分析。还通过 Cox 比例风险模型对影响胰腺癌特异性生存率的因素进行了多因素分析。
结果
在 2010-2013 年期间，共确定了 18948 例胰腺腺癌患者。在病理分期患者中，根据第 8 版分期，除了 IA 期和 IB 期（P = 0.307）和 IB 期和 IIA 期（P = 0.116）之间的比较外，所有分期之间的胰腺癌特异性生存率均有显著差异（P < 0.0001）。此外，IA 期与 IIA 期的 P 值为 0.014；而在病理分期患者中，根据第 7 版分期，所有分期之间的胰腺癌特异性生存率均有显著差异（P < 0.0001），除了 IA 期和 IB 期（P = 0.072）、IIA 期和 IIB 期（P = 0.065）、IIA 期和 III 期（P = 0.059）以及 IIB 期和 III 期（P = 0.595）之间的比较外。在临床分期患者（即未行初始根治性手术的患者）中，第 7 版和第 8 版的总体生存率和胰腺癌特异性生存率的预后表现均有限。
结论
显然需要有两种胰腺腺癌分期系统：病理分期系统和临床分期系统。
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