Department of Thoracic Surgery, Qilu Hospital of Shandong University(Qingdao), Qingdao, P.R. China.
Department of Respiratory Medicine, Yidu Central Hospital of Weifang, Weifang, China.
Cancer Med. 2020 Jul;9(13):4648-4655. doi: 10.1002/cam4.2997. Epub 2020 May 11.
The evaluation of the eighth edition of ypTNM staging system for patients with esophageal cancer was limited in the setting of neoadjuvant therapy.
A total of 2324 patients with esophageal cancer receiving radio(chemo)therapy prior to surgery from the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013 were eligible for the analysis. Kaplan-Meier method and Cox proportional hazards models were used to estimate overall survivals.
Among patients with preoperative therapy, both the seventh edition TNM grouping and the eighth edition ypTNM grouping could significantly stratify the overall survival (both log-rank P < .001). There was not significant difference in the C-index of the seventh edition TNM grouping (0.575; 95%CI, 0.558-0.593) and the eighth edition ypTNM grouping (0.569; 95%CI, 0.551-0.587) (P = .098). In multivariable Cox analysis, ypN category was the strongest predictor of overall survival (P < .001), followed by tumor grade (HR, 1.33; 95%CI, 1.12-1.56; P = .001). The combination of ypT, ypN, and ypG categories yielded significantly higher C-index (0.591; 95%CI, 0.573-0.609) than that of the seventh edition TNM staging (P = .024).
Tumor grade remained an independent predictor of overall survival in the setting of neoadjuvant therapy, and could improve the performance of ypTNM staging system.
在新辅助治疗的背景下，对食管癌患者的第八版 ypTNM 分期系统的评估受到限制。
从 2004 年至 2013 年，SEER 数据库中共有 2324 名接受术前放化疗的食管癌患者符合分析条件。Kaplan-Meier 方法和 Cox 比例风险模型用于估计总生存率。
在接受术前治疗的患者中，第七版 TNM 分组和第八版 ypTNM 分组均能显著分层总生存率（对数秩 P<0.001）。第七版 TNM 分组的 C 指数（0.575；95%CI，0.558-0.593）和第八版 ypTNM 分组（0.569；95%CI，0.551-0.587）之间无显著差异（P=0.098）。在多变量 Cox 分析中，ypN 分期是总生存的最强预测因素（P<0.001），其次是肿瘤分级（HR，1.33；95%CI，1.12-1.56；P=0.001）。ypT、ypN 和 ypG 分期的组合产生的 C 指数显著高于第七版 TNM 分期（0.591；95%CI，0.573-0.609）（P=0.024）。
在新辅助治疗的背景下，肿瘤分级仍然是总生存的独立预测因素，并且可以提高 ypTNM 分期系统的性能。
