Pei Jun-Peng, Zhang Chun-Dong, Fu Xiang, Ba Yong, Yue Shuai, Zhao Zhe-Ming, Dai Dong-Qiu
Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China.
Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan.
J Cancer. 2021 Apr 5;12(11):3299-3306. doi: 10.7150/jca.55097. eCollection 2021.
Several revisions of the TNM classifications for colorectal cancer (CRC) have acknowledged that the oncological outcomes of stage IIB/IIC CRC are worse than those of stage IIIA. We aimed to develop a novel TNM (nTNM) classification based on the metro-ticket paradigm. We identified eligible CRC patients from the Surveillance, Epidemiology, and End Results database. The nTNM was developed using distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages, and was compared with the AJCC TNM classification. The areas under the curves (AUCs), calibration curves, and Akaike's information criterion (AIC) were used to evaluate the predictive performances of the two classifications. Clinical benefits were further estimated by decision curve analyses. The validation cohort was applied to validate these findings. A total of 58,192 CRC patients (40,736 training cohort, 17,456 validation cohort) were finally included. In the training cohort, 18,476 patients (45.4%) experienced upstaging and 15,907 patients (39.0%) experienced downstaging in the nTNM classification compared with the TNM classification. Taking the prognosis of stage I as the reference, survival decreased with increasing nTNM stage. The nTNM classification showed better discrimination (AUC, 0.678 vs. 0.667, <0.001), model-fitting (AIC, 236,525 vs. 237,741), and clinical benefits than the TNM classification. Similar results were found in the validation cohort. The nTNM classification for CRC has better predictive performances and superior accuracy for predicting prognosis compared with the TNM classification. The nTNM classification should therefore be considered in future revisions of the TNM classification.
结直肠癌（CRC）的TNM分类法经过多次修订，已经承认IIB/IIC期CRC的肿瘤学结局比IIIA期更差。我们旨在基于地铁票范式开发一种新的TNM（nTNM）分类法。我们从监测、流行病学和最终结果数据库中识别出符合条件的CRC患者。nTNM分类法是利用笛卡尔平面上距原点的距离开发的，该平面纳入了pN（x轴）和pT（y轴）分期，并与美国癌症联合委员会（AJCC）的TNM分类法进行比较。曲线下面积（AUC）、校准曲线和赤池信息准则（AIC）用于评估两种分类法的预测性能。通过决策曲线分析进一步估计临床获益。应用验证队列来验证这些发现。最终共纳入58192例CRC患者（40736例训练队列，17456例验证队列）。在训练队列中，与TNM分类法相比，nTNM分类法中有18476例患者（45.4%）出现分期上调，15907例患者（39.0%）出现分期下调。以I期的预后为参照，nTNM分期越高，生存率越低。与TNM分类法相比，nTNM分类法显示出更好的区分度（AUC，0.678对0.667，<0.001）、模型拟合度（AIC，236525对237741）和临床获益。在验证队列中也发现了类似结果。与TNM分类法相比，CRC的nTNM分类法在预测预后方面具有更好的预测性能和更高的准确性。因此，在TNM分类法的未来修订中应考虑nTNM分类法。
