Peyroteo Mariana, Martins Pedro Carvalho, Canotilho Rita, Correia Ana Margarida, Baía Catarina, Sousa Alexandre, Brito Donzília, Videira José Flávio, Santos Lúcio Lara, de Sousa Abreu
Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, EPE, Porto, 4200-072, Portugal.
https://orcid.org/0000-0002-0941-2533.
Ecancermedicalscience. 2020 Oct 15;14:1124. doi: 10.3332/ecancer.2020.1124. eCollection 2020.
The 8th edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer introduced changes, mainly in stage III, with the incorporation of the pN3 sub-classification in the final staging group. The goal was to compare the 7th and 8th editions to evaluate the discriminative capacity of the new edition.
This study was a retrospective review of patients with gastric cancer treated with surgery in 2013 and 2014.
We analysed 310 patients, with a median age of 66 years and out of which 55.5% were male. The most commonly performed surgery was subtotal gastrectomy ( = 158; 51%), with a median of 30 lymph nodes removed. With a median follow-up of 39.5 months, the 1- and 3-year overall survival (OS) was 82% and 59%, respectively. In stage III ( = 115), there was stage migration in 40 cases (34.8%), with upstage in 11 cases and downstage in 29 cases. In this group, there was a statistically significant difference in OS between N3a and N3b patients ( = 0.002), as well as a statistically significant difference in OS between stages IIIA, IIIB and IIIC when the 8th edition was applied ( = 0.001), which was not verified with the 7th edition ( = 0.057). In multivariate analysis, both extracapsular extension and N classification from TNM were independent prognostic factors ( = 0.033 and = 0.024, respectively).
The 8th edition of the AJCC TNM classification allows for a better prognostic refinement, namely in the new stage III groups after the stratification of lymph node disease in N3a and N3b. Factors that evaluate the biological behaviour of the disease remain excluded from this edition, such as extracapsular extension, which had a prognostic impact in our series.
美国癌症联合委员会（AJCC）第8版胃癌TNM分类引入了一些变化，主要在III期，最终分期组纳入了pN3亚分类。目的是比较第7版和第8版，以评估新版的鉴别能力。
本研究是对2013年和2014年接受手术治疗的胃癌患者的回顾性分析。
我们分析了310例患者，中位年龄为66岁，其中55.5%为男性。最常施行的手术是胃大部切除术（n = 158；51%），中位切除淋巴结数为30个。中位随访39.5个月，1年和3年总生存率（OS）分别为82%和59%。在III期（n = 115），40例（34.8%）出现分期迁移，其中11例分期上调，29例分期下调。在该组中，N3a和N3b患者的OS存在统计学显著差异（P = 0.002），应用第8版时IIIA、IIIB和IIIC期之间的OS也存在统计学显著差异（P = 0.001），而第7版未证实这一点（P = 0.057）。多因素分析显示，包膜外侵犯和TNM分类中的N分级均为独立预后因素（分别为P = 0.033和P = 0.024）。
AJCC第8版TNM分类能更好地进行预后细化，即在根据N3a和N3b对淋巴结疾病进行分层后的新III期组中。该版仍未纳入评估疾病生物学行为的因素，如包膜外侵犯，而在我们的系列研究中其对预后有影响。
