Giannis Dimitrios, Cerullo Marcelo, Moris Dimitrios, Shah Kevin N, Herbert Garth, Zani Sabino, Blazer Dan G, Allen Peter J, Lidsky Michael E
Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, USA.
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Cancers (Basel). 2021 Feb 1;13(3):547. doi: 10.3390/cancers13030547.
The scope of our study was to compare the predictive ability of American Joint Committee on Cancer (AJCC) 7th and 8th edition in gallbladder carcinoma (GBC) patients, investigate the effect of AJCC 8th nodal status on the survival, and identify risk factors associated with the survival after N reclassification using the National Cancer Database (NCDB) in the period 2005-2015. The cohort consisted of 7743 patients diagnosed with GBC; 202 patients met the criteria for reclassification and were denoted as stage ≥III by AJCC 7th and 8th edition criteria. Overall survival concordance indices were similar for patients when classified by AJCC 8th (OS c-index: 0.665) versus AJCC 7th edition (OS c-index: 0.663). Relative mortality was higher within strata of T1, T2, and T3 patients with N2 compared with N1 stage (T1 HR: 2.258, < 0.001; T2 HR: 1.607, < 0.001; Τ3 HR: 1.306, < 0.001). The risk of death was higher in T1-T3 patients with Nx compared with N1 stage (T1 HR: 1.281, = 0.043, T2 HR: 2.221, < 0.001, T3 HR: 2.194, < 0.001). In patients with AJCC 8th edition stage ≥IIIB GBC and an available grade, univariate analysis showed that higher stage, Charlson-Deyo score ≥ 2, higher tumor grade, and unknown nodal status were associated with an increased risk of death, while year of diagnosis after 2013, academic center, chemotherapy. and radiation therapy were associated with decreased risk of death. Chemotherapy and radiation therapy were associated with decreased risk of death in patients with T3-T4 and T2-T4 GBC, respectively. In conclusion, the updated AJCC 8th GBC staging system was comparable to the 7th edition, with the recently implemented changes in N classification assessment failing to improve the prognostic performance of the staging system. Further prospective studies are needed to validate the T2 stage subclassification as well as to clarify the association, if any is actually present, between advanced N staging and increased risk of death in patients of the same T stage.
我们研究的范围是比较美国癌症联合委员会（AJCC）第7版和第8版对胆囊癌（GBC）患者的预测能力，研究AJCC第8版淋巴结状态对生存的影响，并利用2005 - 2015年期间的国家癌症数据库（NCDB）确定N重新分类后与生存相关的危险因素。该队列由7743例诊断为GBC的患者组成；202例患者符合重新分类标准，根据AJCC第7版和第8版标准被判定为≥III期。按AJCC第8版（总生存c指数：0.665）与AJCC第7版（总生存c指数：0.663）分类时，患者的总生存一致性指数相似。与N1期相比，N2期的T1、T2和T3患者亚组中的相对死亡率更高（T1风险比：2.258，<0.001；T2风险比：1.607，<0.001；T3风险比：1.306，<0.001）。与N1期相比，Nx的T1 - T3患者死亡风险更高（T1风险比：1.281，=0.043；T2风险比：2.221，<0.001；T3风险比：2.194，<0.001）。在AJCC第8版≥IIIB期GBC且有分级信息的患者中，单因素分析显示，更高分期、Charlson - Deyo评分≥2、更高肿瘤分级和未知淋巴结状态与死亡风险增加相关，而2013年后的诊断年份、学术中心、化疗和放疗与死亡风险降低相关。化疗和放疗分别与T3 - T4和T2 - T4期GBC患者的死亡风险降低相关。总之，更新后的AJCC第8版GBC分期系统与第7版相当，最近实施的N分类评估变化未能改善分期系统的预后性能。需要进一步的前瞻性研究来验证T2期亚分类，以及明确如果确实存在的话，在相同T期患者中晚期N分期与死亡风险增加之间的关联。
