Oweira Hani, Abdel-Rahman Omar, Mehrabi Arianeb, Reissfelder Christoph
Center for Visceral and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Switzerland.
Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
J Gastrointest Oncol. 2019 Jun;10(3):421-428. doi: 10.21037/jgo.2019.01.15.
The current study evaluates the validity and performance of the 8 edition of the American Joint Committee on Cancer (AJCC) staging system for small intestinal adenocarcinoma patients.
Surveillance, Epidemiology and End Results (SEER) database [2004-2015] was explored and AJCC 6, 7, and 8 versions were assigned for each patient. Through Kaplan-Meier estimates, overall survival analyses were conducted. Cox regression analysis (adjusted for age, race, gender, sub-site, grade and surgical treatment) was conducted for cancer-specific survival and additionally, pairwise hazard ratio comparisons were performed.
A total of 2,997 small intestinal adenocarcinoma patients were eligible and included in the analysis. Overall survival was compared according to the three AJCC staging systems. For the three versions, the P value for the trend in overall survival was significant (P<0.0001). Cancer-specific Cox regression hazard was calculated for the three staging systems. Pairwise hazard ratio comparisons between different AJCC 6 stages were conducted and all P values for comparisons were significant (P<0.0001). Pairwise hazard ratio comparisons between different AJCC 7 and 8 stages were also performed, and all comparisons were significant (P<0.05) except for stage IIB . IIIA. C-statistic (using death from small intestinal adenocarcinoma as the dependent variable) for AJCC 6 staging system was: 0.645 [standard error (SE): 0.011; 95% CI: 0.623-0.668]; for c-statistic for AJCC 7 staging system was 0.658 (SE: 0.011; 95% CI: 0.637-0.680); while c-statistic for AJCC 8 staging system was 0.660 (SE: 0.011; 95% CI: 0.638-0.682). Multivariate analysis of factors affecting cancer-specific survival suggested that older age (P=0.005), higher lymph node ratio (P<0.0001) and duodenal localization of the primary are associated with worse outcomes (P=0.008).
There is no evidence that AJCC 8 system provided better prognostic characterization compared to previous AJCC staging systems for small intestinal adenocarcinoma. Subsite-specific staging paradigms should be explored in future editions of the staging system.
本研究评估了美国癌症联合委员会（AJCC）第8版分期系统对小肠腺癌患者的有效性和性能。
探索监测、流行病学和最终结果（SEER）数据库[2004 - 2015年]，并为每位患者分配AJCC第6、7和8版分期。通过Kaplan-Meier估计进行总生存分析。对癌症特异性生存进行Cox回归分析（根据年龄、种族、性别、亚部位、分级和手术治疗进行调整），此外，还进行了成对风险比比较。
共有2997例小肠腺癌患者符合条件并纳入分析。根据三种AJCC分期系统比较总生存。对于这三个版本，总生存趋势的P值具有显著性（P<0.0001）。计算了三种分期系统的癌症特异性Cox回归风险。对不同AJCC第6期进行成对风险比比较，所有比较的P值均具有显著性（P<0.0001）。还对不同AJCC第7和8期进行了成对风险比比较，除IIB.IIIA期外，所有比较均具有显著性（P<0.05）。AJCC第6版分期系统的C统计量（以小肠腺癌死亡为因变量）为：0.645[标准误（SE）：0.011；95%置信区间：0.623 - 0.668]；AJCC第7版分期系统的C统计量为0.658（SE：0.011；95%置信区间：0.637 - 0.680）；而AJCC第8版分期系统的C统计量为0.660（SE：0.011；95%置信区间：0.638 - 0.682）。影响癌症特异性生存的因素的多变量分析表明，年龄较大（P = 0.005）、淋巴结比例较高（P<0.0001）和原发灶位于十二指肠与较差的预后相关（P = 0.008）。
没有证据表明与之前的AJCC小肠腺癌分期系统相比，AJCC第8版系统能提供更好的预后特征。分期系统的未来版本应探索亚部位特异性分期模式。
