基于单患者预后分类算法对Ⅱ/Ⅲ期胃癌TNM分期系统的修正
Modification of the TNM Staging System for Stage II/III Gastric Cancer Based on a Prognostic Single Patient Classifier Algorithm.
作者信息
Choi Yoon Young, Jang Eunji, Seo Won Jun, Son Taeil, Kim Hyoung-Il, Kim Hyeseon, Hyung Woo Jin, Huh Yong-Min, Noh Sung Hoon, Cheong Jae-Ho
机构信息
Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Biomedical Research Institute, Yonsei University Health System, Yonsei University College of Medicine, Seoul, Korea.
出版信息
J Gastric Cancer. 2018 Jun;18(2):142-151. doi: 10.5230/jgc.2018.18.e14. Epub 2018 May 31.
PURPOSE
The modification of the cancer classification system aimed to improve the classical anatomy-based tumor, node, metastasis (TNM) staging by considering tumor biology, which is associated with patient prognosis, because such information provides additional precision and flexibility.
MATERIALS AND METHODS
We previously developed an mRNA expression-based single patient classifier (SPC) algorithm that could predict the prognosis of patients with stage II/III gastric cancer. We also validated its utilization in clinical settings. The prognostic single patient classifier (pSPC) differentiates based on 3 prognostic groups (low-, intermediate-, and high-risk), and these groups were considered as independent prognostic factors along with TNM stages. We evaluated whether the modified TNM staging system based on the pSPC has a better prognostic performance than the TNM 8th edition staging system. The data of 652 patients who underwent gastrectomy with curative intent for gastric cancer between 2000 and 2004 were evaluated. Furthermore, 2 other cohorts (n=307 and 625) from a previous study were assessed. Thus, 1,584 patients were included in the analysis. To modify the TNM staging system, one-grade down-staging was applied to low-risk patients according to the pSPC in the TNM 8th edition staging system; for intermediate- and high-risk groups, the modified TNM and TNM 8th edition staging systems were identical.
RESULTS
Among the 1,584 patients, 187 (11.8%), 664 (41.9%), and 733 (46.3%) were classified into the low-, intermediate-, and high-risk groups, respectively, according to the pSPC. pSPC prognoses and survival curves of the overall population were well stratified, and the TNM stage-adjusted hazard ratios of the intermediate- and high-risk groups were 1.96 (95% confidence interval [CI], 1.41-2.72; P<0.001) and 2.54 (95% CI, 1.84-3.50; P<0.001), respectively. Using Harrell's C-index, the prognostic performance of the modified TNM system was evaluated, and the results showed that its prognostic performance was better than that of the TNM 8th edition staging system in terms of overall survival (0.635 vs. 0.620, P<0.001).
CONCLUSIONS
The pSPC-modified TNM staging is an alternative staging system for stage II/III gastric cancer.
目的
癌症分类系统的改进旨在通过考虑与患者预后相关的肿瘤生物学来完善基于经典解剖学的肿瘤、淋巴结、转移（TNM）分期，因为此类信息可提供更高的精确性和灵活性。
材料与方法
我们之前开发了一种基于mRNA表达的单患者分类器（SPC）算法，该算法可预测II/III期胃癌患者的预后。我们还在临床环境中验证了其应用。预后单患者分类器（pSPC）基于3个预后组（低风险、中风险和高风险）进行区分，并且这些组与TNM分期一起被视为独立的预后因素。我们评估了基于pSPC的改良TNM分期系统是否比TNM第8版分期系统具有更好的预后性能。对2000年至2004年间因胃癌接受根治性胃切除术的652例患者的数据进行了评估。此外，还评估了先前一项研究中的另外2个队列（n = 307和625）。因此，1584例患者被纳入分析。为了改良TNM分期系统，在TNM第8版分期系统中，根据pSPC对低风险患者进行一级降期；对于中风险和高风险组，改良TNM分期系统与TNM第8版分期系统相同。
结果
在1584例患者中，根据pSPC，分别有187例（11.8%）、664例（41.9%）和733例（46.3%）被分类为低风险、中风险和高风险组。总体人群的pSPC预后和生存曲线得到了很好的分层，中风险和高风险组经TNM分期调整后的风险比分别为1.96（95%置信区间[CI]，1.41 - 2.72；P < 0.001）和2.54（95%CI，1.84 - 3.50；P < 0.001）。使用Harrell's C指数评估了改良TNM系统的预后性能，结果显示在总生存方面，其预后性能优于TNM第8版分期系统（0.635对0.620，P < 0.001）。
结论
pSPC改良的TNM分期是II/III期胃癌的一种替代分期系统。
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