结直肠癌临床分期与病理分期的相关性：新辅助治疗的意义。
Correlation Between Clinical and Pathologic Staging in Colon Cancer: Implications for Neoadjuvant Treatment.
机构信息
John Wayne Cancer Institute at Providence St John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
Medical Data Research Center, Providence Health & Services, Portland, OR, USA.
出版信息
J Gastrointest Surg. 2018 Oct;22(10):1764-1771. doi: 10.1007/s11605-018-3777-y. Epub 2018 May 22.
BACKGROUND
Recent randomized trials suggest improved outcomes in patients with locally advanced colon cancer (LACC) treated with neoadjuvant chemotherapy (NAC). Optimal selection of patients for NAC depends on accurate clinical staging. The purpose of this study was to examine the degree of correlation between clinical and pathologic staging in patients with colon cancer (CC).
METHODS
Adult patients with non-metastatic CC who underwent surgery were identified from the National Cancer Data Base between 2006 and 2014. Data on clinical and pathologic staging was obtained. Kappa index was used to determine the correlation between clinical and pathologic staging.
RESULTS
One hundred five thousand five hundred sixty-nine patients were identified. The overall correlation rate between clinical and pathologic staging for T stage was 80% (kappa 0.7) and 83% for N stage (kappa 0.6). The correlation rate was 54% for T1, 76% for T2, 95% for T3, and 94% for T4 (P < 0.001). This compared with 81% for N0, 82% for N1, and 97% for N2 (P < 0.001). The sensitivity and specificity of clinical staging for identifying T3/T4 vs T1/T2 were 80 and 98%, respectively, compared to 60 and 98% for N1/N2 vs N0 (P < 0.001).
CONCLUSIONS
Our findings suggest that current modalities used for clinical staging are accurate in predicting pathologic stage for advanced but not early T and N disease. Further optimization of clinical staging is essential for the accurate selection of patients who may benefit from neoadjuvant therapy and to avoid overtreatment of low-risk patients.
背景
最近的随机试验表明，接受新辅助化疗（NAC）治疗的局部晚期结肠癌（LACC）患者的结局得到改善。NAC 患者的最佳选择取决于准确的临床分期。本研究的目的是检查结肠癌（CC）患者临床分期和病理分期之间的相关性程度。
方法
从 2006 年至 2014 年，从国家癌症数据库中确定了接受手术治疗的非转移性 CC 成年患者。获取了临床和病理分期的数据。Kappa 指数用于确定临床分期和病理分期之间的相关性。
结果
确定了 105569 例患者。T 分期的临床和病理分期之间的总体相关性率为 80%（kappa 值为 0.7），N 分期为 83%（kappa 值为 0.6）。T1 的相关性率为 54%，T2 为 76%，T3 为 95%，T4 为 94%（P<0.001）。与之相比，N0 的相关性率为 81%，N1 为 82%，N2 为 97%（P<0.001）。临床分期识别 T3/T4 与 T1/T2 的灵敏度和特异性分别为 80%和 98%，而 N1/N2 与 N0 的灵敏度和特异性分别为 60%和 98%（P<0.001）。
结论
我们的研究结果表明，目前用于临床分期的方法在预测晚期 T 和 N 疾病的病理分期方面是准确的，但对早期 T 和 N 疾病的预测则不然。进一步优化临床分期对于准确选择可能受益于新辅助治疗的患者以及避免对低危患者的过度治疗至关重要。
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