Deng Jianqing, Chu Xiangyang, Ren Zhipeng, Wang Bo
Department of Thoracic Surgery, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing, People's Republic of China.
Medicine (Baltimore). 2020 May;99(19):e20064. doi: 10.1097/MD.0000000000020064.
To shed light on the interaction between the American Joint Committee on Cancer (AJCC) T stage and M stage in the determination of the overall survival (OS) and cancer-specific survival (CSS) of esophageal carcinoma patients. Moreover, to confirm our hypothesis that tumors that metastasize to distant sites in the early T stage may reflect a more biologically aggressive disease compared with those that metastasize in more advanced T stages.We performed a retrospective cohort study with patients who were pathologically diagnosed with esophageal cancer between 2004 and 2014 in the surveillance epidemiology and end results (SEER) database. The primary study variables were the T and M stage, as well as their interaction terms. We performed a survival analysis of the interaction terms using unadjusted Kaplan-Meier methods and adjusted Cox proportional hazards models. Furthermore, we performed an exploratory analysis with stratification by histological type, esophageal adenocarcinoma (EAC), and esophageal squamous cell carcinoma (ESCC).Data of 19,078 patients were retrieved from the SEER database. Unadjusted Kaplan-Meier curve indicated that patients with T2 and T3 stage had longer median OS and CSS (3 months and 4 months, respectively) than with T1 stage in distantly metastatic esophageal cancer (M1 stage). Multivariate analysis revealed a significant interaction between the T stage and M stage when determining the OS and CSS of esophageal cancer (P < .001). Using T1M0 as a reference, patients with T1M1 had significantly worse OS and CSS than those with T2M1 and T3M1 stage (P < .001). A similar pattern was also observed among patients with EAC and ESCC.Our analysis suggests that the T1 stage predicts worse survival compared with T2 and T3 stage in distantly metastatic esophageal cancer and might be a surrogate for biologically aggressive disease, indicating that those patients should receive more aggressive treatments. Our findings also encourage researchers to discover new genomic changes in this subset of tumors with the potential to uncover new prognostic markers or drug targets. Further researches on the association between T stage and survival in metastatic esophageal cancer are warranted to validate our findings.
为了阐明美国癌症联合委员会（AJCC）的T分期与M分期在确定食管癌患者总生存期（OS）和癌症特异性生存期（CSS）方面的相互作用。此外，为了证实我们的假设，即与那些在较晚期T分期发生转移的肿瘤相比，在早期T分期就发生远处转移的肿瘤可能反映出一种生物学行为更具侵袭性的疾病。
我们对2004年至2014年间在监测、流行病学和最终结果（SEER）数据库中经病理诊断为食管癌的患者进行了一项回顾性队列研究。主要研究变量为T分期和M分期及其交互项。我们使用未调整的Kaplan-Meier方法和调整后的Cox比例风险模型对交互项进行生存分析。此外，我们还按组织学类型、食管腺癌（EAC）和食管鳞状细胞癌（ESCC）进行分层的探索性分析。
从SEER数据库中检索到19078例患者的数据。未调整的Kaplan-Meier曲线表明，在远处转移的食管癌（M1期）中，T2期和T3期患者的中位OS和CSS（分别为3个月和4个月）比T1期患者更长。多变量分析显示，在确定食管癌的OS和CSS时，T分期和M分期之间存在显著的交互作用（P<0.001）。以T1M0为参照，T1M1期患者的OS和CSS显著差于T2M1期和T3M1期患者（P<0.001）。在EAC和ESCC患者中也观察到类似的模式。
我们的分析表明，在远处转移的食管癌中，与T2期和T3期相比，T1期预示着更差的生存期，可能是生物学行为侵袭性疾病的一个替代指标，这表明这些患者应接受更积极的治疗。我们的研究结果还鼓励研究人员在这一肿瘤亚组中发现新的基因组变化，有可能揭示新的预后标志物或药物靶点。有必要对转移性食管癌中T分期与生存期之间的关联进行进一步研究，以验证我们的研究结果。
