Wei Y Z, Huang Y Q, Zeng S Y, Cai Z B, Peng Y H, Zhu C L, Yu W L, Zhou Y M
School of Clinical Medicine, Fujian Medical University, Fuzhou 350122, China.
Department of Oncological Surgery, First Affiliated Hospital of Xiamen University, Cancer Center of Xiamen, Xiamen 361003, China.
Zhonghua Yi Xue Za Zhi. 2021 Jul 27;101(28):2216-2222. doi: 10.3760/cma.j.cn112137-20201231-03527.
To assess the accuracy of the American Joint Committee on Cancer (AJCC) 8th edition staging system for hepatocellular carcinoma (HCC) and to make an appropriate modification. Data of patients diagnosed with HCC who underwent surgery were extracted from 2004 to 2015 within the SEER database. Overall survival (OS) and disease-specific survival (DSS) of patients were analyzed. A total of 7 911 patients were included and there were 2 117 females and 5 794 males. The male-to-female ratio was 1.00: 0.36. There were 4 050 patients older than 60 years old. Tumor size ranged from 24 to 65 mm. Tumors with single lobes (80.8%) or single lesions (62.8%) were more common. There were 230 cases and 2 052 cases received radiotherapy and chemotherapy, accounting for 2.9% and 25.9%, respectively. The median follow-up was 42 months. Analysis of the 8th edition of AJCC staging system showed that the survival curves of ⅣA stage and ⅢA stage intersected in both OS and DSS, and the differences were not statistically significant between them (both >0.05). Analysis of patients in subgroup of ⅣA stage showed that there was no statistically significant difference in the four groups of T1N1M0/T2N0M0, T2N1M0/T3N0M0, T3N1M0/T4N0-1M0 and T3N1M0/T1-4N0-1M1 (all >0.05). Therefore, the modified 8th edition of the AJCC staging system was proposed after retaining the definition of T/N/M in the old edition: ⅠA and ⅠB stages were retained; ⅣA stage was split: T1N1M0 was included in Ⅱ stage, T2N1M0 in Ⅲ stage, and Ⅳ stage included T3N1M0, T4N0-1M0 and T1-4N0-1M1. Cox proportional risk regression analysis of the modified 8th edition of the AJCC staging showed that significant differences were observed among the four groups, with ⅠB/ⅠA (=1.462, 95%:1.294-1.651), Ⅱ/ⅠB (=1.091, 95%:1.003-1.186), Ⅲ/Ⅱ (=2.034, 95%: 1.793-2.307) and Ⅲ/Ⅳ (=1.374, 95%: 1.192-1.583) for OS, respectively. The similar findings were seen in DSS, with ⅠB/ⅠA (=2.007, 95%:1.671-2.411), Ⅱ/ⅠB (=1.140, 95%:1.023-1.271), Ⅲ/Ⅱ (=2.344, 95%: 2.018-2.724) and Ⅲ/Ⅳ (=1.391, 95%:1.180-1.639), respectively. The modified AJCC 8th edition staging system could predict the survival outcome of HCC more accurately.
评估美国癌症联合委员会（AJCC）第8版肝细胞癌（HCC）分期系统的准确性并进行适当修改。从监测、流行病学与最终结果（SEER）数据库中提取2004年至2015年接受手术的HCC患者的数据。分析患者的总生存期（OS）和疾病特异性生存期（DSS）。共纳入7911例患者，其中女性2117例，男性5794例。男女比例为1.00:0.36。年龄大于60岁的患者有4050例。肿瘤大小范围为24至65毫米。单叶肿瘤（80.8%）或单个病灶（62.8%）更为常见。接受放疗和化疗的患者分别有230例和2052例，占2.9%和25.9%。中位随访时间为42个月。对AJCC第8版分期系统的分析表明，ⅣA期和ⅢA期的生存曲线在OS和DSS中均相交，两者之间差异无统计学意义（均>0.05）。对ⅣA期亚组患者的分析表明，T1N1M0/T2N0M0、T2N1M0/T3N0M0、T3N1M0/T4N0 - 1M0和T3N1M0/T1 - 4N0 - 1M1这四组之间差异无统计学意义（均>0.05）。因此，在保留旧版T/N/M定义的基础上，提出修改后的AJCC第8版分期系统：保留ⅠA期和ⅠB期；ⅣA期拆分：T1N1M0纳入Ⅱ期，T2N1M0纳入Ⅲ期，Ⅳ期包括T3N1M0、T4N0 - 1M0和T1 - 4N0 - 1M1。对修改后的AJCC第8版分期进行Cox比例风险回归分析表明，四组之间存在显著差异，OS时ⅠB/ⅠA（=1.462，95%：1.294 - 1.651）、Ⅱ/ⅠB（=1.091，95%：1.003 - 1.186）、Ⅲ/Ⅱ（=2.034，95%：1.793 - 2.307）和Ⅲ/Ⅳ（=1.374，95%：1.192 - 1.583）。DSS也有类似结果，ⅠB/ⅠA（=2.007，95%：1.671 - 2.411）、Ⅱ/ⅠB（=1.140，95%：1.023 - 1.271）、Ⅲ/Ⅱ（=2.344，95%：2.018 - 2.724）和Ⅲ/Ⅳ（=1.391，95%：1.180 - 1.639）。修改后的AJCC第8版分期系统能更准确地预测HCC的生存结局。
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