Cramer John D, Reddy Abhita, Ferris Robert L, Duvvuri Umamaheswar, Samant Sandeep
Department of Otolaryngology-Head and Neck Surgery, UPMC, Pittsburgh, Pennsylvania.
Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, U.S.A.
Laryngoscope. 2018 Oct;128(10):2351-2360. doi: 10.1002/lary.27205. Epub 2018 Apr 15.
For the first time in 30 years, the eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual offers major changes in the staging of oral cavity cancer. We evaluated the predictive ability of the new staging system for oral cavity cancer to validate these changes and hypothesized that the new system would improve prognostic accuracy.
We conducted a retrospective cohort study of patients with oral cavity squamous cell carcinoma in the National Cancer Data Base from 2009 to 2013 and applied the seventh and eighth edition staging AJCC staging systems to all patients. Stage-specific overall survival was calculated using the Kaplan-Meier method and concordance indices to measure the system's prognostic accuracy.
We identified 39,361 patients with a median follow-up of 27.1 months (range 0.1-80.4 months). In the seventh edition, there were 43.0%, 15.0%, 10.6%, and 25.7% of patients with pathologic stage I, II, III, and IV disease, respectively. After restaging based on eighth edition pathological guidelines, 10.0% of patients were upstaged (38.1%, 18.1%, 14.2%, and 25.2%, respectively, with stage I, II, III, and IV disease, respectively). The survival concordance index improved from the seventh to eighth edition for pathological staging (concordance index 0.699 and 0.704, respectively) and for clinical staging (concordance index 0.714 and 0.715, respectively).
We provide validation of the new AJCC staging system for oral cavity cancer. Eighth edition AJCC staging guidelines upstage a substantial number of patients with greater depth of invasion or extranodal extension. This resulted in slightly improved prognostication.
2c. Laryngoscope, 128:2351-2360, 2018.
美国癌症联合委员会（AJCC）分期手册第八版在30年来首次对口腔癌分期做出了重大改变。我们评估了口腔癌新分期系统的预测能力，以验证这些改变，并假设新系统将提高预后准确性。
我们对2009年至2013年国家癌症数据库中口腔鳞状细胞癌患者进行了一项回顾性队列研究，并将第七版和第八版AJCC分期系统应用于所有患者。使用Kaplan-Meier方法计算特定阶段的总生存率，并使用一致性指数来衡量系统的预后准确性。
我们确定了39361例患者，中位随访时间为27.1个月（范围0.1 - 80.4个月）。在第七版中，病理分期为I、II、III和IV期疾病的患者分别占43.0%、15.0%、10.6%和25.7%。根据第八版病理指南重新分期后，10.0%的患者分期上调（I、II、III和IV期疾病的患者分别为38.1%、18.1%、14.2%和25.2%）。病理分期从第七版到第八版的生存一致性指数有所提高（一致性指数分别为0.699和0.704），临床分期也是如此（一致性指数分别为0.714和0.715）。
我们对口腔癌新AJCC分期系统进行了验证。第八版AJCC分期指南使大量具有更深浸润深度或结外扩展的患者分期上调。这导致预后预测略有改善。
2c。《喉镜》，2018年，第128卷，第2351 - 2360页。
