Yousef Yacoub A, Qaddoumi Ibrahim, Al-Nawaiseh Ibrahim, Mohammad Mona, AlRimawi Dalia, Toro Mario Damiano, Zweifel Sandrine, Rejdak Robert, Nazzal Rashed, Mehyar Mustafa, Jaradat Imad, Sultan Iyad, Al-Hussaini Maysa
Department of Surgery (Ophthalmology), King Hussein Cancer Centre, Amman, Jordan.
Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
J Cancer. 2022 Feb 7;13(4):1336-1345. doi: 10.7150/jca.61005. eCollection 2022.
The 8 edition of the American Joint Committee on Cancer (AJCC) staging manual incorporated new changes from its 7 edition for classifying retinoblastoma (RB). We assessed the comparative prognostic values of the 7 and 8 editions of the AJCC clinical (cTNM) staging manuals for RB and suggested modifications for future edition accordingly. A retrospective, observational study. King Hussein Cancer Centre. A cohort of 478 patients and 565 eyes with RB. Main outcome measures included demographics; tumor features, AJCC cTNM stage, and eye salvage rates. The prognostic performance of the different staging systems was assessed with the concordance index (C-index) and likelihood ratio χ tests. The overall eye salvage rate was 65%. Stage migration occurred for 330 (48%) eyes with the AJCC Staging Manual, 8 edition. Based on the 7 edition AJCC staging, the eye salvage rate was 94% (n=177) for T1 tumors (98% for T1a, 93%for T1b, and 90%for T1c), 69% (n=204) for T2 tumors (73% for T2a and 62%for T2b), and 51% (n=40) for T3 tumors. Based on the 8 edition AJCC staging, the eye salvage rate was 95% (n=139) for T1 tumors (98% for T1a and 93% for T1b), 68% (n=281) for T2 tumors (90%for T2a and 66%for T2b), and 12% (n=1) for T3 tumors. With our proposed cTNM modifications, the eye salvage rate was 94% (n=177) for T1 tumors (98%for T1a, 93%for T1b, and 90% for T1c), 66% (n=243) for T2 tumors (73% for T2a, 62% for T2b, and 55% for T2c), and 12% (n=1) for T3 tumors. As estimated by odds ratios, more advanced cTNM stage (regardless of the cTNM staging system) was significantly associated with an increased chance of treatment failure ( < .0001). The C-index for both the 8 edition and the proposed modifications were approximately equal, and both were higher than that of the 7 edition. However, the proposed modifications had the highest likelihood ratio χ value and the best bootstrap 95% confidence interval. Our proposed modifications on the clinical TNM Staging System for RB harbor more detailed subgroup classification criteria that provides better prognostic value for eye globe salvage than the published similar (but not identical) AJCC Staging Manual, 7 and 8 editions, furthermore these modifications may resolve the discrepancies in the previously published different classification systems for RB.
美国癌症联合委员会（AJCC）第8版分期手册纳入了与第7版相比视网膜母细胞瘤（RB）分类的新变化。我们评估了AJCC第7版和第8版临床（cTNM）分期手册对RB的比较预后价值，并据此为未来版本提出修改建议。一项回顾性观察研究。侯赛因国王癌症中心。478例RB患者及565只眼的队列。主要观察指标包括人口统计学；肿瘤特征、AJCC cTNM分期和眼球挽救率。采用一致性指数（C指数）和似然比χ检验评估不同分期系统的预后性能。总体眼球挽救率为65%。使用AJCC第8版分期手册时，330只眼（48%）出现分期迁移。基于AJCC第7版分期，T1期肿瘤的眼球挽救率为94%（n = 177）（T1a为98%，T1b为93%，T1c为90%），T2期肿瘤为69%（n = 204）（T2a为73%，T2b为62%），T3期肿瘤为51%（n = 40）。基于AJCC第8版分期，T1期肿瘤的眼球挽救率为95%（n = 139）（T1a为98%，T1b为93%），T2期肿瘤为68%（n = 281）（T2a为90%，T2b为66%），T3期肿瘤为12%（n = 1）。根据我们提出的cTNM修改建议，T1期肿瘤的眼球挽救率为94%（n = 177）（T1a为98%，T1b为93%，T1c为90%），T2期肿瘤为66%（n = 243）（T2a为73%，T2b为62%，T2c为55%），T3期肿瘤为12%（n = 1）。经比值比估计，更高级别的cTNM分期（无论cTNM分期系统如何）与治疗失败几率增加显著相关（P < .0001）。第8版及提出的修改建议的C指数大致相等，且均高于第7版。然而，提出的修改建议具有最高的似然比χ值和最佳的自抽样95%置信区间。我们对RB临床TNM分期系统提出的修改建议包含更详细的亚组分类标准，与已发表的类似（但不完全相同）的AJCC第7版和第8版分期手册相比，对眼球挽救具有更好的预后价值，此外，这些修改建议可能解决先前发表的RB不同分类系统中的差异。
