Proposed Modification of Nodal Staging as an Alternative to the Seventh Edition of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System Improves the Prognostic Prediction in the Resected Esophageal Squamous-Cell Carcinoma
Proposed Modification of Nodal Staging as an Alternative to the Seventh Edition of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System Improves the Prognostic Prediction in the Resected Esophageal Squamous-Cell Carcinoma
复制标题
提议修改淋巴结分期作为美国癌症肿瘤-淋巴结-转移分期系统联合委员会第七版的替代方案，改善切除食管鳞状细胞癌的预后预测
DOI：
10.1097/jto.0000000000000580
复制
发表时间：
2015-07-01
影响因子：
20.4
通讯作者：
Jiang, Jing-ting
中科院分区：
文献类型：
--
作者：
Ning, Zhong-hua;Wang, Zhi-gang;Jiang, Jing-ting
简介：第7届美国癌症联合委员会（AJCC）食管癌肿瘤-淋巴结-转移分期系统根据转移性淋巴结（LN）的数量定义了N分类。然而，这种分类可能会忽略淋巴结转移的程度。本研究的目的是修订N分类的淋巴结转移的程度的基础上，并提出一个修改目前的AJCC分期系统，更好地代表中国食管鳞状细胞癌（ESCC）的预后特点。方法：我们回顾性分析了1993年ESCC患者进行根治性切除术。通过单变量和多变量考克斯回归分析，将基于淋巴结转移站数量的建议N分类与当前分期系统进行比较。采用似然比（2）统计和Akaike信息标准计算比较两种分期系统的同质性、区分能力和梯度单调性。结果：基于第7 AJCC分期系统，N2与N3分类（p = 0.231）和IIIB期与IIIC期（p = 0.713）的生存差异无显著性。采用改良的分期系统时，N2与N3、IIIB与IIIC的生存差异可以很好地区分。统计学分析表明，改良的分期系统比第7 AJCC分期系统具有更高的似然比（2）评分和更小的Akaike信息标准值，代表了最佳的预后分层。结论：改良的基于淋巴结转移数目N分类的分期系统比第7 AJCC分期系统更能预测中国ESCC患者的生存率。需要进一步的研究来证实这一结果。
Introduction: The 7th American Joint Committee on Cancer (AJCC) tumor-node-metastasis staging system for esophageal cancer defined N classification based on the number of metastatic lymph nodes (LNs). However, this classification might neglect the extent of LNs metastasis. This study aimed to revise N classification based on the extent of LNs metastasis and propose a modification to the current AJCC staging system for better representing the prognostic characteristics of Chinese esophageal squamous-cell carcinoma (ESCC).Methods: We retrospectively reviewed 1993 ESCC patients who underwent curative resection. The proposed N categories based on the number of LNs metastasis stations were compared with the current staging system by univariate and multivariate Cox regression analyses. Homogeneity, discriminatory ability, and monotonicity of gradients of two staging systems were compared using likelihood ratio (2) statistics and Akaike information criterion calculations.Results: The survival differences were not significant for N2 versus N3 category (p = 0.231) and stages IIIB versus IIIC (p = 0.713) based on the 7th AJCC staging system. When the modified staging system was adopted, the survival difference for N2 versus N3 and IIIB versus IIIC could be well discriminated. Statistical analysis showed that the modified staging system had higher likelihood ratio (2) scores and smaller Akaike information criterion values than the 7th AJCC staging system, which represented the optimum prognostic stratification.Conclusions: The modified staging system with the revised N categories based on the number of LNs metastasis stations better predicts the survival of Chinese ESCC population than the 7th AJCC staging system. Further studies are required to confirm this result.