Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan.
Ann Surg Oncol. 2021 Feb;28(2):650-660. doi: 10.1245/s10434-020-09181-3. Epub 2020 Oct 6.
The 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system provided a specific 'ypTNM' stage grouping for patients with esophageal cancer.
This study aimed to evaluate the clinical utility of the AJCC 8th edition ypTNM stage grouping for patients with esophageal squamous cell carcinoma (ESCC).
We enrolled 152 patients with ESCC who underwent surgery after neoadjuvant cisplatin plus 5-fluorouracil (CF) therapy between June 2005 and December 2011. ypStage was evaluated according to the AJCC 7th and 8th editions. Predictive performance for disease-specific survival (DSS) and overall survival (OS) was compared between both editions. The prognostic significance of ypTNM stage grouping was evaluated using univariate and multivariate analyses.
Revision of the AJCC 7th edition to the 8th edition was associated with a change in ypStage in 96 patients (63.2%). The AJCC 8th edition revealed a better predictive performance than the 7th edition in terms of DSS (Akaike's information criterion [AIC] 499 vs. 513; Bayesian information criterion [BIC] 505 versus 519; concordance index [C-index] 0.725 versus 0.679) and OS (AIC 662 vs. 674; BIC 669 vs. 681; C-index 0.662 vs. 0.622). On univariate and multivariate analyses, ypStage in the 8th edition was an independent prognostic factor for both DSS and OS.
ypTNM stage grouping in the AJCC 8th edition provided a better predictive performance for DSS and OS than that in the 7th edition. ypStage in the 8th edition was the most reliable prognostic factor for ESCC patients who underwent surgery after neoadjuvant CF therapy.
第 8 版美国癌症联合委员会（AJCC）TNM 分期系统为食管癌患者提供了特定的“ypTNM”分期分组。
本研究旨在评估 AJCC 第 8 版 ypTNM 分期分组对食管鳞状细胞癌（ESCC）患者的临床应用价值。
我们纳入了 152 例接受新辅助顺铂加 5-氟尿嘧啶（CF）治疗后于 2005 年 6 月至 2011 年 12 月行手术治疗的 ESCC 患者。根据 AJCC 第 7 版和第 8 版评估 yp 分期。比较两版在疾病特异性生存（DSS）和总生存（OS）预测性能上的差异。采用单因素和多因素分析评估 ypTNM 分期分组的预后意义。
将 AJCC 第 7 版修订为第 8 版，96 例（63.2%）患者的 yp 分期发生变化。第 8 版 AJCC 在 DSS（Akaike 信息量标准[AIC]为 499 与 513；贝叶斯信息量标准[BIC]为 505 与 519；一致性指数[C 指数]为 0.725 与 0.679）和 OS（AIC 为 662 与 674；BIC 为 669 与 681；C 指数为 0.662 与 0.622）方面的预测性能优于第 7 版。在单因素和多因素分析中，第 8 版 yp 分期是 DSS 和 OS 的独立预后因素。
与第 7 版相比，AJCC 第 8 版的 ypTNM 分期分组对 DSS 和 OS 的预测性能更好。第 8 版 yp 分期是接受新辅助 CF 治疗后行手术治疗的 ESCC 患者最可靠的预后因素。
