Wang Li, Dong Ping, Zhang Yi, Yang Min, Chen Yang, Tian Bo-Le
Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China.
Oncol Lett. 2018 Oct;16(4):4427-4433. doi: 10.3892/ol.2018.9189. Epub 2018 Jul 23.
In December 2016, the Union for International Cancer Control (UICC) published the 8th edition of the Tumor-Node-Metastasis (TNM) classification of malignant tumors, including a number of vital changes in the definitions of the T2 category, the N category and the stages of gallbladder cancer (GBC). The clinical value of this newly updated classification in patients with surgically treated GBC has not been rigorously validated. The present study aimed to analyze the prognosis of patients with GBC in a high-volume surgical unit, and to validate the prognostic value of the new UICC TNM classification, particularly the main changes in the stages of GBC. Data from 307 patients who were surgically treated and histopathologically diagnosed with GBC between January 2011 and July 2016 in The West China Hospital (Chengdu, Sichuan, China) were retrospectively collected and analyzed. The new UICC criteria distributed 32, 60, 99 and 116 eligible patients in stages I, II, III and IV, respectively. The differences in overall survival time between each stage (I-IV) demonstrated statistical significance (P<0.05). As a result of the main change of this classification, the novel definitions of T2a and T2b effectively stratified the prognosis of patients with T2 GBC (P<0.001). Furthermore, patients with stage IIa tumors also obtained significantly improved overall survival time compared with patients with stage IIb tumors (P=0.04), whereas the comparison between patients with stage IIb and IIIa tumors did not present any notable difference (P=0.20). Additionally, the new N category stratified the survival of the patients effectively (P<0.001). Together with curative resection, this latest classification was indicated to be an independent predictor of survival via multivariate analysis (hazard ratio, 6.25; 95% confidence interval, 3.81-10.26; P<0.001). In conclusion, the newly updated UICC TNM classification could effectively reflect the clinical outcome of patients with surgically treated GBC. Furthermore, tumor location could predict the survival of surgically treated T2 GBC. The novel classification of the N category by the number of lymph nodes involved was also demonstrated to be valid.
2016年12月，国际癌症控制联盟（UICC）发布了恶性肿瘤的第8版肿瘤-淋巴结-转移（TNM）分类，其中包括胆囊癌（GBC）的T2类别、N类别和分期定义中的一些重要变化。这种新更新的分类在接受手术治疗的GBC患者中的临床价值尚未得到严格验证。本研究旨在分析在一个高容量手术科室中GBC患者的预后，并验证新的UICC TNM分类的预后价值，特别是GBC分期的主要变化。回顾性收集并分析了2011年1月至2016年7月期间在四川大学华西医院（中国四川成都）接受手术治疗并经组织病理学诊断为GBC的307例患者的数据。新的UICC标准将32例、60例、99例和116例符合条件的患者分别分为I期、II期、III期和IV期。各期（I-IV期）之间的总生存时间差异具有统计学意义（P<0.05）。由于该分类的主要变化，T2a和T2b的新定义有效地对T2 GBC患者的预后进行了分层（P<0.001）。此外，IIa期肿瘤患者的总生存时间也比IIb期肿瘤患者有显著改善（P=0.04），而IIb期和IIIa期肿瘤患者之间的比较没有显示出任何显著差异（P=0.20）。此外，新的N类别有效地对患者的生存进行了分层（P<0.001）。通过多因素分析表明，与根治性切除一起，这种最新分类是生存的独立预测因素（风险比，6.25；95%置信区间，3.81-10.26；P<0.001）。总之，新更新的UICC TNM分类可以有效地反映接受手术治疗的GBC患者的临床结局。此外，肿瘤位置可以预测接受手术治疗的T2 GBC患者的生存情况。通过受累淋巴结数量对N类别进行的新分类也被证明是有效的。
