Department of Oncology, Republic of Korea; Division of Hematology/Oncology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Oncology, Republic of Korea; Thoracic and Cardiovascular Surgery, Republic of Korea.
Surg Oncol. 2020 Dec;35:491-497. doi: 10.1016/j.suronc.2020.10.015. Epub 2020 Oct 24.
The American Joint Committee on Cancer 8th edition staging system presents separate classifications for pTNM and post-neoadjuvant ypTNM (ypTNM-8th) to enhance prognostic prediction after neoadjuvant therapy and surgery. We aimed to validate the ypTNM-8th staging system and to compare the prognostication performance of ypTNM-8th with that of pTNM-7th and pTNM-8th in esophageal squamous cell carcinoma (ESCC) patients receiving neoadjuvant chemoradiotherapy (nCRT).
We reviewed 207 ESCC patients treated with nCRT between January 2007 and December 2014 and compared the Akaike information criterion (AIC) and Harrell's C-index to determine the prognostic performance of each TNM system.
Survival curve analysis of pTNM-7th and -8th showed a stepwise drop in survival from ypT0N0 to advanced stages, whereas the survival outcome of ypStage III showed a better prognosis than that of ypStage II according to ypTNM-8th. Lymphovascular invasion, perineural invasion, and tumor regression grade were significantly associated with overall survival on univariate analysis. Each TNM system showed significant p-values for trend (p < 0.0001 each), but after adjusting for prognostic factors, ypTNM-8th did not significantly predict survival (p = 0.15), whereas pTNM-7th remained significant (p < 0.001). pTNM-7th incorporating ypT0N0M0 and ypT0 (is)N + M0 as separate groups was superior in prognostication as its AIC was smaller and its C-index was higher than those of pTNM-8th and ypTNM-8th, respectively.
Because ypTNM-8th did not provide sufficient prognostication for patients with ESCC treated with nCRT followed by esophagectomy, more sophisticated prognostic classification should be developed for the ypTNM staging system in these patients.
美国癌症联合委员会第八版分期系统为新辅助治疗和手术后的预后预测提供了 pTNM 和新辅助后ypTNM（ypTNM-8）的单独分类。我们旨在验证 ypTNM-8 分期系统，并比较 ypTNM-8 与 pTNM-7 和 pTNM-8 在接受新辅助放化疗（nCRT）的食管鳞癌（ESCC）患者中的预后预测性能。
我们回顾了 207 例 2007 年 1 月至 2014 年 12 月接受 nCRT 治疗的 ESCC 患者，并比较了 Akaike 信息准则（AIC）和 Harrell 的 C 指数，以确定每个 TNM 系统的预后性能。
pTNM-7 和 -8 的生存曲线分析显示，从 ypT0N0 到晚期阶段的生存率逐渐下降，而根据 ypTNM-8，ypStage III 的生存结果优于 ypStage II。单因素分析显示，脉管侵犯、神经周围侵犯和肿瘤退缩分级与总生存显著相关。每个 TNM 系统的趋势都有显著的 p 值（p<0.0001 各），但在调整预后因素后，ypTNM-8 对生存没有显著预测作用（p=0.15），而 pTNM-7 仍然显著（p<0.001）。将 ypT0N0M0 和 ypT0（is）N+M0 纳入 pTNM-7 的不同分组在预后方面更为优越，因为其 AIC 更小，C 指数高于 pTNM-8 和 ypTNM-8。
由于 ypTNM-8 对接受 nCRT 联合食管癌切除术治疗的 ESCC 患者预后预测不足，因此应针对这些患者的 ypTNM 分期系统开发更复杂的预后分类。
