Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
World J Urol. 2019 Oct;37(10):2165-2173. doi: 10.1007/s00345-018-2603-1. Epub 2018 Dec 15.
We combined county-level socioeconomic status (SES), marital status and insurance status to introduce NBF-stage, which were further incorporated into the American Joint Committee on Cancer (AJCC) TNM staging system to generate an integrated staging system for better prognostication and decision-making for testicular cancer patients.
15,324 eligible patients diagnosed with primary testicular cancer between January 1, 2007 and December 31, 2015 were strictly selected from the Surveillance, Epidemiology, and End Results (SEER) database. Independent survival predictors were determined based on Cox proportional hazards model. The Kaplan-Meier survival curves were conducted to describe the difference in predicting survival probability and the Multivariate Cox proportion hazard regression analyses were established to compare the cancer-specific survival (CSS) and overall survival (OS) difference among NBF stages or NBF-TNM subgroups.
County-level SES, marital status and insurance status were independent prognostic non-biological factors (NBFs) in our study (P < 0.05). NBF-stage (combination of SES, marital status, and insurance status) was also an independent survival predictor in TC (P < 0.05). NBF1 patients had 167% increased risk of cancer-specific mortality (CSM) as compared to NBF0 patients in testicular cancer (P < 0.01). And NBF0 patients all had a better CSS as compared to NBF1 patients of the same TNM stage both in seminoma and non-seminomatous germ cell tumor (P < 0.05).
Incorporation of NBFs into AJCC TNM staging system in testicular cancer would potentially impact treatment decisions where treatments would not be rendered for a typically curable cancer with multi-modal therapy.
我们将县级社会经济地位（SES）、婚姻状况和保险状况相结合，引入 NBF 分期，并将其进一步纳入美国癌症联合委员会（AJCC）TNM 分期系统，以生成一种综合分期系统，用于更好地预测和决策睾丸癌患者的预后。
从监测、流行病学和最终结果（SEER）数据库中严格筛选出 2007 年 1 月 1 日至 2015 年 12 月 31 日期间诊断为原发性睾丸癌的 15324 名合格患者。基于 Cox 比例风险模型确定独立的生存预测因子。进行 Kaplan-Meier 生存曲线以描述预测生存概率的差异，并建立多变量 Cox 比例风险回归分析以比较 NBF 分期或 NBF-TNM 亚组之间的癌症特异性生存（CSS）和总生存（OS）差异。
县级 SES、婚姻状况和保险状况是我们研究中的独立预后非生物学因素（NBFs）（P<0.05）。NBF 分期（SES、婚姻状况和保险状况的组合）也是 TC 的独立生存预测因子（P<0.05）。与 NBF0 期患者相比，NBF1 期患者的癌症特异性死亡率（CSM）增加了 167%（P<0.01）。在精原细胞瘤和非精原细胞瘤生殖细胞肿瘤中，NBF0 期患者的 CSS 均优于相同 TNM 分期的 NBF1 期患者（P<0.05）。
将 NBF 纳入 AJCC TNM 分期系统可能会影响睾丸癌的治疗决策，对于通常可以通过多模式治疗治愈的癌症，不再进行治疗。
