对美国癌症联合委员会第8版新型分期手册用于无功能性胰腺神经内分泌肿瘤患者长期生存情况的全面验证。
A comprehensive validation of the novel 8th edition of American Joint Committee on Cancer staging manual for the long-term survivals of patients with non-functional pancreatic neuroendocrine neoplasms.
作者信息
Yang Min, Zeng Lin, Yao Wen-Qing, Ke Neng-Wen, Tan Chun-Lu, Tian Bo-le, Liu Xu-Bao, Xiang Bo, Zhang Yi
机构信息
Department of Pediatric Surgery.
President & Dean's Office.
出版信息
Medicine (Baltimore). 2020 Nov 13;99(46):e22291. doi: 10.1097/MD.0000000000022291.
Histologically, the World Health Organization has classified pancreatic neuroendocrine neoplasms (p-NENs) into well-differentiated pancreatic neuroendocrine tumors (G1/G2 p-NETs) and poorly-differentiated pancreatic neuroendocrine carcinoma (G3 p-NECs) based on tumor mitotic counts and Ki-67 index. Recently, the 8th edition of American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging manual has incorporated some major changes in 2017 that the TNM staging system for p-NENs should only be applied to well-differentiated G1/G2 p-NETs, while poorly-differentiated G3 p-NECs be classified according to the new system for pancreatic exocrine adenocarcinomas. However, this new manual for p-NENs has seldom been evaluated.Data of patients with both G1/G2 and G3 non-functional p-NENs (NF-p-NENs) from our institution was retrospectively collected and analyzed using 2 new AJCC 8th staging systems. We also made survival comparisons between the 8th and 7th edition system separately for different subgroups.For G1/G2 NF-p-NETs, there were 52 patients classified in AJCC 8th edition stage I, 40 in stage II, 41 in stage III and 19 in stage IV. As for G3 NF-p-NECs, 17, 19, 24, and 18 patients were respectively defined from AJCC 8th edition stage I to stage IV. In terms of the AJCC 7th staging system, the 230 patients with NF-p-NENs were totally distributed from stage I to stage IV (94, 63, 36, 37, respectively). For the survival analysis of both G1/G2 NF-p-NETs and G3 NF-p-NECs, the AJCC 7th edition system failed to discriminate the survival differences when compared stage III with stage II or stage IV (P > .05), while the 8th edition ones could perfectly allocate patients into 4 statistically different groups (P < .05). The HCIs of AJCC 8th stage for G1/G2 NF-p-NETs [HCI=0.658, 95% confidence interval (CI)=0.602-0.741] and stage for G3 NF-p-NECs (HCI=0.704, 95% CI=0.595-0.813) was both statistically larger than those of AJCC 7th stage for different grading NF-p-NENs [(HCI=0.578, 95% CI=0.557-0.649; P=.031), (HCI=0.546, 95% CI=0.531-0.636; P = .019); respectively], indicating a more accurate predictive ability for the survivals of NF-p-NENs.Our data suggested the 2 new AJCC 8th staging systems were superior to its 7th edition for patients with both G1/G2 NF-p-NETs and G3 NF-p-NECs.
在组织学上，世界卫生组织已根据肿瘤有丝分裂计数和Ki-67指数将胰腺神经内分泌肿瘤（p-NENs）分为高分化胰腺神经内分泌肿瘤（G1/G2 p-NETs）和低分化胰腺神经内分泌癌（G3 p-NECs）。最近，美国癌症联合委员会（AJCC）第8版肿瘤-淋巴结-转移（TNM）分期手册在2017年纳入了一些重大变化，即p-NENs的TNM分期系统仅适用于高分化G1/G2 p-NETs，而低分化G3 p-NECs应根据胰腺外分泌腺癌的新系统进行分类。然而，这本关于p-NENs的新手册很少得到评估。我们回顾性收集并分析了本机构G1/G2和G3非功能性p-NENs（NF-p-NENs）患者的数据，采用了2种新的AJCC第8版分期系统。我们还分别对不同亚组在第8版和第7版系统之间进行了生存比较。
对于G1/G2 NF-p-NETs，AJCC第8版分期中I期有52例患者，II期有40例，III期有41例，IV期有19例。至于G3 NF-p-NECs，AJCC第8版分期中I期至IV期分别有17、19、24和18例患者。在AJCC第7版分期系统中，230例NF-p-NENs患者从I期到IV期均有分布（分别为94、63、36、37例）。对于G1/G2 NF-p-NETs和G3 NF-p-NECs的生存分析，AJCC第7版系统在比较III期与II期或IV期时未能区分生存差异（P>0.05），而第8版系统能够完美地将患者分为4个具有统计学差异的组（P<0.05）。AJCC第8版G1/G2 NF-p-NETs分期的Harrell一致性指数（HCI）[HCI=0.658，95%置信区间（CI）=0.602-0.741]和G3 NF-p-NECs分期的HCI（HCI=0.704，95% CI=0.595-0.813）在统计学上均高于AJCC第7版不同分级NF-p-NENs分期的HCI[（HCI=0.578，95% CI=0.557-0.649；P=0.031），（HCI=0.546，95% CI=0.531-0.636；P=0.019）；分别]，表明对NF-p-NENs生存的预测能力更准确。
我们的数据表明，对于G1/G2 NF-p-NETs和G3 NF-p-NECs患者，AJCC第8版的2种新分期系统优于第7版。
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