Zanoni Andrea, Verlato Giuseppe, Baiocchi Gian Luca, Casella Francesco, Cossu Andrea, d'Ignazio Alessia, De Pascale Stefano, Giacopuzzi Simone
Unit of General Surgery, Rovereto Hospital (APSS of Trento), Corso Verona 4, Rovereto, TN, Italy.
General and Upper G.I. Surgery Division, University of Verona, Verona, Italy.
Updates Surg. 2018 Jun;70(2):241-249. doi: 10.1007/s13304-018-0537-1. Epub 2018 May 28.
Siewert III cancers were classified as esophageal cancers by the TNM 7th edition (TNM7), while being defined as gastric cancers by the new TNM 8th edition (TNM8). Aim of this study was to compare previous and present TNM classifications of Siewert III. From 2000 to 2015, 309 patients with Siewert III adenocarcinoma were treated at ten high-volume centers, belonging to the GIRCG (Italian Research Group for Gastric Cancer). We retrospectively analyzed overall survival according to TNM classifications: gastric TNM8 was compared with either gastric TNM7 or esophageal TNM7. Median number of lymph nodes harvested was 31 (interquartile range 22-44). Agreement between gastric TNM7 and TNM8 was very good (weighted kappa 92.3%, IC 95% 90.3-94.1%). Accordingly, stage migration was observed in 54 of 309 patients (17.5%), with 12 patients upstaged (3.9%) and 42 downstaged (13.6%). Cox models including either gastric TNM7 or TNM8 achieved similar goodness-of-fit and c-index. Differences were much larger, when shifting from esophageal TNM7 to gastric TNM8: the agreement was much lower (weighted kappa 69.1%, 65.2-73.2%), with 196 of 309 patients (63.4%) downstaging. The corresponding Cox model presented the lowest goodness-of-fit and discrimination ability. Gastric TNM7 and TNM8 were largely superimposable, so that stage migration was minor and prognostic significance was similar. At variance, stage migration was substantial when shifting from esophageal TNM7 to TNM8. Moreover, survival models with esophageal TNM7 presented the worst goodness-of-fit and the lowest discrimination ability. This further supports placing Siewert III among gastric cancers, as done in TNM8.
根据第7版《肿瘤学国际疾病分类》（TNM7），Siewert III型癌症被归类为食管癌，而根据新的第8版《肿瘤学国际疾病分类》（TNM8），则被定义为胃癌。本研究的目的是比较Siewert III型癌症之前和当前的TNM分类。2000年至2015年期间，意大利胃癌研究组（GIRCG）下属的10个高容量中心共治疗了309例Siewert III型腺癌患者。我们根据TNM分类对总生存期进行了回顾性分析：将胃癌TNM8与胃癌TNM7或食管癌TNM7进行比较。收集的淋巴结中位数为31个（四分位间距为22 - 44个）。胃癌TNM7与TNM8之间的一致性非常好（加权kappa值为92.3%，95%置信区间为90.3 - 94.1%）。相应地，309例患者中有54例（17.5%）出现了分期迁移，其中12例患者分期上调（3.9%），42例患者分期下调（13.6%）。包含胃癌TNM7或TNM8的Cox模型具有相似的拟合优度和c指数。当从食管癌TNM7转换为胃癌TNM8时，差异要大得多：一致性要低得多（加权kappa值为69.1%，65.2 - 73.2%），309例患者中有196例（63.4%）分期下调。相应的Cox模型拟合优度和判别能力最低。胃癌TNM7和TNM8在很大程度上是重叠的，因此分期迁移较小，预后意义相似。相比之下，从食管癌TNM7转换为TNM8时，分期迁移很大。此外，采用食管癌TNM7的生存模型拟合优度最差，判别能力最低。这进一步支持了如TNM8中那样将Siewert III型癌症归类为胃癌。
