美国癌症联合委员会（AJCC）第8版yTNM分期系统在单中心食管癌队列中的应用显示预后有所改善。
Application of the 8th edition of the AJCC yTNM staging system shows improved prognostication in a single center cohort of esophageal carcinomas.
作者信息
Kröll Dino, Noser Laura, Erdem Suna, Storni Federico, Arnold Dominik, Dislich Bastian, Zlobec Inti, Candinas Daniel, Seiler Christian A, Langer Rupert
机构信息
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Pathology, Department of Clinical Pathology, University of Bern, Switzerland.
出版信息
Surg Oncol. 2018 Mar;27(1):100-105. doi: 10.1016/j.suronc.2017.12.005. Epub 2018 Jan 31.
BACKGROUND
The 8th edition of the AJCC TNM staging system presents for the first time a specific classification for esophageal carcinomas treated with neoadjuvant therapy (yTNM8). In this single center study, we applied the novel staging system in a "real life" case series and compared the prognostic value of yTNM8 with the preceding 7th edition (TNM7).
METHODS
Out of 272 consecutive esophageal carcinomas that were treated during a 15-year period in one surgical center, all 198 cases that had undergone neoadjuvant therapy were reviewed and classified according to TNM7 and yTNM8.
RESULTS
50 ypT0 cases that had no specific staging in TNM7 were included into stages I (ypT0N0M0; n = 42), IIIA (ypT0N1M0; n = 6), IVA (ypT0N3M0; n = 1) and IVB (ypT0N0M1; n = 1) in yTNM8. Both systems showed significant prognostic impact (p < 0.0001 each). yTNM8 was superior regarding prognostication with lower values for goodness-of-fit criteria (Akaike Information Criterion 1589.331 vs 1593.239; and Schwarz Bayesian Criterion 1605.487 vs.1619.088). However, in TNM7, stage IIB tumors had better prognosis than stage IIA tumors, and likewise, stage IIIA tumors better compared to stage II in yTNM8.
CONCLUSIONS
yTNM8 allows accurate staging of esophageal carcinomas treated by neoadjuvant therapy, with slightly improved prognostication compared to TNM7. Additional data acquisition will be necessary for further improvement of staging for esophageal carcinomas after neoadjuvant treatment.
背景
美国癌症联合委员会（AJCC）TNM分期系统第8版首次提出了接受新辅助治疗的食管癌的特定分类（yTNM8）。在这项单中心研究中，我们在一个“实际病例”系列中应用了这种新的分期系统，并比较了yTNM8与之前第7版（TNM7）的预后价值。
方法
在一个外科中心15年期间连续治疗的272例食管癌中，对所有198例接受新辅助治疗的病例进行回顾，并根据TNM7和yTNM8进行分类。
结果
TNM7中无特定分期的50例ypT0病例在yTNM8中被归入I期（ypT0N0M0；n = 42）、IIIA期（ypT0N1M0；n = 6）、IVA期（ypT0N3M0；n = 1）和IVB期（ypT0N0M1；n = 1）。两种系统均显示出显著的预后影响（p均<0.0001）。yTNM8在预后预测方面更具优势，拟合优度标准值更低（赤池信息准则1589.331对1593.239；施瓦茨贝叶斯准则1605.487对1619.088）。然而，在TNM7中，IIB期肿瘤的预后优于IIA期肿瘤，同样，在yTNM8中，IIIA期肿瘤的预后优于II期肿瘤。
结论
yTNM8能够对接受新辅助治疗的食管癌进行准确分期，与TNM7相比，预后预测略有改善。为进一步改善新辅助治疗后食管癌的分期，还需要获取更多数据。
Zotero 插件