Department of Pathology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Cancer Res Treat. 2019 Jan;51(1):98-111. doi: 10.4143/crt.2017.595. Epub 2018 Mar 2.
PURPOSE: T category of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system for distal bile duct carcinoma (DBDC) was changed to include tumor invasion depth measurement, while the N category adopted a 3-tier classification system based on the number of metastatic nodes. MATERIALS AND METHODS: To validate cancer staging, a total of 200 surgically resected DBDCs were staged and compared according to the seventh and eighth editions. RESULTS: T categories included T1 (n=37, 18.5%), T2 (n=114, 57.0%), and T3 (n=49, 24.5%). N categories included N0 (n=133, 66.5%), N1 (n=50, 25.0%), and N2 (n=17, 8.5%). Stage groupings included I (n=33, 16.5%), II (n=150, 75.0%), and III (n=17, 8.5%). The overall 5-year survival rates (5-YSRs) of T1, T2, and T3 were 59.3%, 42.4%, and 12.2%, respectively. T category could discriminate patient survival by both pairwise (T1 and T2, p=0.011; T2 and T3, p < 0.001) and overall (p < 0.001) comparisons. The overall 5-YSRs of N0, N1, and N2 were 47.3%, 17.0%, and 14.7%, respectively. N category could partly discriminate patient survival by both pairwise (N0 and N1, p < 0.001; N1 and N2, p=0.579) and overall (p < 0.001) comparisons. The overall 5-YSRs of stages I, II, and III were 59.0%, 35.4%, and 14.7%, respectively. Stages could distinguish patient survival by both pairwise (I and II, p=0.002; II and III, p=0.015) and overall (p < 0.001) comparisons. On multivariate analyses, T and N categories (p=0.014 and p=0.029) and pancreatic invasion (p=0.006) remained significant prognostic factors. CONCLUSION: The T andNcategories of the eighth edition AJCC staging system for DBDC accurately predict patient prognosis.
目的:第八版美国癌症联合委员会(AJCC)远端胆管癌(DBDC)分期系统的 T 分期类别改为包括肿瘤侵袭深度测量,而 N 分期采用基于转移淋巴结数量的 3 级分类系统。
材料与方法:为了验证癌症分期,对 200 例手术切除的 DBDC 进行分期,并根据第七版和第八版进行比较。
结果:T 分期包括 T1(n=37,18.5%)、T2(n=114,57.0%)和 T3(n=49,24.5%)。N 分期包括 N0(n=133,66.5%)、N1(n=50,25.0%)和 N2(n=17,8.5%)。分期组包括 I(n=33,16.5%)、II(n=150,75.0%)和 III(n=17,8.5%)。T1、T2 和 T3 的总 5 年生存率(5-YSR)分别为 59.3%、42.4%和 12.2%。T 分期可以通过两两比较(T1 和 T2,p=0.011;T2 和 T3,p<0.001)和整体比较(p<0.001)来区分患者的生存情况。N0、N1 和 N2 的总 5-YSR 分别为 47.3%、17.0%和 14.7%。N 分期可以通过两两比较(N0 和 N1,p<0.001;N1 和 N2,p=0.579)和整体比较(p<0.001)来部分区分患者的生存情况。I、II 和 III 期的总 5-YSR 分别为 59.0%、35.4%和 14.7%。分期可以通过两两比较(I 和 II,p=0.002;II 和 III,p=0.015)和整体比较(p<0.001)来区分患者的生存情况。多因素分析显示,T 分期和 N 分期(p=0.014 和 p=0.029)和胰腺侵犯(p=0.006)仍然是重要的预后因素。
结论:第八版 AJCC 远端胆管癌分期系统的 T 和 N 分期能够准确预测患者的预后。
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