Department of General Surgery, Changzheng Hospital, the Second Military Medical University, Shanghai, China.
Department of the VIP section, Changzheng Hospital, the Second Military Medical University, Shanghai, China.
Cancer Med. 2020 Nov;9(21):7979-7987. doi: 10.1002/cam4.3431. Epub 2020 Sep 8.
The aim of our study was to explore the value of the 8th edition TNM staging system on evaluating the prognosis of colorectal carcinoid. Colorectal carcinoid patients between 1988 and 2015 were selected in the Surveillance, Epidemiology, and End Results Program (SEER) database for analysis. About 4286 patients with colorectal carcinoid tumors were identified, of which were carcinoid tumor NOS (n = 1726), neuroendocrine carcinoma (NEC) (n = 1346) and other carcinoid tumor (OCT) (n = 591). Worsening 10-year CSS rates with increasing N status, M status, and SEER historic stage were demonstrated across all three above groups (all P < .05). In carcinoid tumor NOS, significant differences in CSS were found with increasing combined 8th AJCC stages (P < .001), except for that between stage II and stage III (10-year CSS rate: 82.6% vs 84.3%, P = .68). While combined 8th TNM stage in NEC and OTC exhibited greater separations in CSS despite on-going overlaps between groups. For carcinoid tumor NOS, stage II (HR = 3.37; 95% CI: 0.97-11.76), and stage III (HR = 2.09; 95% CI: 0.51-8.66) conferred no significant difference in CSS compared with stage I, while stage IV had an increasing HR of 5.09 (95% CI: 1.08-24.08). Although combined 8th AJCC stage had a good ability to distinguish 10-year CSS of patients with NEC or OCT, detailed 8th AJCC stage did not seem to be applicable. Detailed 8th AJCC categories of advanced stages in all the three groups conferred increased HRs with overlapping CIs. However, in the early and middle status, HRs did not increase with the increase of stages, or there was no difference in HRs between adjacent stages. Combined 8th TNM stage was not practical for judging the survival outcomes of colorectal carcinoid tumor NOS, especially in patients with stages II and III, but it provided useful prognostic information for NEC and OCT. However, for all carcinoid tumors, the prognostic values of detailed 8th AJCC stage were not enough accurate in the clinic. More optimized staging methods should be developed and validated in the future.
我们的研究目的是探讨第 8 版 TNM 分期系统在评估结直肠类癌预后中的价值。我们在 SEER 数据库中选择了 1988 年至 2015 年间的结直肠类癌患者进行分析。共确定了 4286 例结直肠类癌患者，其中包括类癌肿瘤NOS（n=1726）、神经内分泌癌（NEC）（n=1346）和其他类癌肿瘤（OCT）（n=591）。在所有三组中，随着 N 状态、M 状态和 SEER 历史分期的增加，10 年 CSS 率均显示恶化（均 P<.05）。在类癌肿瘤 NOS 中，随着第 8 版 AJCC 联合分期的增加，CSS 存在显著差异（P<.001），但第 II 期和第 III 期除外（10 年 CSS 率：82.6%比 84.3%，P=.68）。而 NEC 和 OCT 中联合第 8 版 TNM 分期尽管存在组间重叠，但在 CSS 上表现出更大的分离。对于类癌肿瘤 NOS，与 I 期相比，II 期（HR=3.37；95%CI：0.97-11.76）和 III 期（HR=2.09；95%CI：0.51-8.66）的 CSS 无显著差异，而 IV 期 HR 增加至 5.09（95%CI：1.08-24.08）。尽管第 8 版 AJCC 联合分期具有良好的区分 NEC 或 OCT 患者 10 年 CSS 的能力，但详细的第 8 版 AJCC 分期似乎并不适用。所有三组中晚期的详细第 8 版 AJCC 分类都增加了 HR，且置信区间重叠。然而，在中早期，HR 并未随分期增加而增加，或相邻分期之间 HR 无差异。第 8 版联合 TNM 分期对判断结直肠类癌肿瘤 NOS 的生存结局并不实用，尤其是在 II 期和 III 期患者中，但它为 NEC 和 OCT 提供了有用的预后信息。然而，对于所有的类癌肿瘤，详细的第 8 版 AJCC 分期在临床上的预后价值不够准确。未来应开发和验证更优化的分期方法。
