Yang Tingsong, Fong Zhi Ven, Pak Linda, Wang Shengnan J, Wei Jia, Wang Jiping
Department of General Surgery, Shanghai Tenth Peoples' Hospital, Tongji University of Medicine, Shanghai.
Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
J Surg Res. 2022 Feb;270:486-494. doi: 10.1016/j.jss.2021.10.002. Epub 2021 Nov 17.
The eighth edition of the American Joint Committee on Cancer (AJCC) staging manual's TNM staging classification for gastric neuroendocrine tumors has been shown to have poor prognostic discriminability. The aim of present study was to propose a modified T-stage classification, and externally validate its performance in a separate population data registry.
A modified T-stage classification with tumor size and extent of tumor invasion was generated from the National Cancer Database between 2004 and 2014 (n = 1249). External validation was performed using the Surveillance, Epidemiology, and End Results registry between 1973 and 2013 (n = 539).
In the National Cancer Database population, using the AJCC T-stage classification, the 5-y survival rates were 85.7%, 80.8%, 64.5%, and 46.1% in T1, T2, T3, and T4 patients respectively (P < 0.001). These rates were more contrasting with the modified T-stage (mT) classification at 87.0%, 78.2%, 59.0%, and 40.3% respectively (P < 0.001). When patients within each of the AJCC T stages were stratified by mT stages, significant survival heterogeneity was observed within each of the AJCC T2 to T4 stages (P < 0.01). Conversely, when mT stages were stratified by AJCC T stage, no survival difference was observed in any of the mT stages (P > 0.05). The same analyses were performed using Surveillance, Epidemiology, and End Results data, and all the observed results were validated.
The current AJCC T stage classification categorizes patients into groups with heterogenous prognosis, thus failing to serve as an effective staging tool. A modified T-stage classification demonstrated significantly improved stratification for patients with gastric neuroendocrine tumors.
美国癌症联合委员会（AJCC）第八版分期手册中胃神经内分泌肿瘤的TNM分期分类已被证明预后判别能力较差。本研究的目的是提出一种改良的T分期分类，并在独立的人群数据登记处对其性能进行外部验证。
从2004年至2014年的国家癌症数据库中生成了一种结合肿瘤大小和肿瘤侵犯范围的改良T分期分类（n = 1249）。使用1973年至2013年的监测、流行病学和最终结果登记处数据进行外部验证（n = 539）。
在国家癌症数据库人群中，使用AJCC T分期分类，T1、T2、T3和T4期患者的5年生存率分别为85.7%、80.8%、64.5%和46.1%（P < 0.001）。这些比率与改良T分期（mT）分类相比差异更大，分别为87.0%、78.2%、59.0%和40.3%（P < 0.001）。当将AJCC每个T分期内的患者按mT分期分层时，在AJCC T2至T4各期内均观察到显著的生存异质性（P < 0.01）。相反，当按AJCC T分期对mT分期进行分层时，在任何mT分期中均未观察到生存差异（P > 0.05）。使用监测、流行病学和最终结果数据进行了相同的分析，所有观察结果均得到验证。
当前的AJCC T分期分类将患者分为预后异质性的组，因此不能作为有效的分期工具。改良的T分期分类对胃神经内分泌肿瘤患者的分层有显著改善。
