Reconsidering the prognostic significance of tumour deposit count in the TNM staging system for colorectal cancer
Reconsidering the prognostic significance of tumour deposit count in the TNM staging system for colorectal cancer
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DOI：
10.1038/s41598-019-57041-2
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发表时间：
2020-01-09
影响因子：
4.6
通讯作者：
Wang, Xishan
中科院分区：
文献类型：
--
作者：
Wang, Song;Guan, Xu;Wang, Xishan
尽管在结直肠癌（CRC）的第8 TNM分期系统中，无转移性淋巴结（mLNs）的肿瘤沉积（TDs）被归类为“N1c”，但TD计数的预后意义仍存在争议。从监测、流行病学和最终结果（SEER）数据库中共收集了39155例结直肠癌患者。使用chi(2)检验评估基线特征与TD状态之间的潜在关联。采用Kaplan-Meier法计算癌症特异性生存（CSS）率，采用logrank检验进行CSS比较。结果显示，TD计数是影响结直肠癌患者预后的重要因素，且TD数量与患者预后呈负相关。我们发现，基于CSS率的比较，一个TD的预后价值相当于两个mln的预后价值。因此，我们提出了一种新的N分级系统，将TD计数纳入N类别，TD与mln的比例为1:2。在每个新N类别中，有无TDs患者的预后没有差异。以1个TD为2个mln的新型TNM分期体系在评价结直肠癌患者预后方面优于TNM第八分期体系中的“N1c”分级。
Although the occurrence of tumour deposits (TDs) without metastatic lymph nodes (mLNs) is classified as "N1c" in the 8th TNM staging system for colorectal cancer (CRC), the prognostic significance of the TD count is still controversial. A total of 39155 CRC patients were collected from the Surveillance, Epidemiology, and End Results (SEER) database. The potential associations between baseline characteristics and TD status were evaluated using the chi(2) test. Cancer-specific survival (CSS) rates were calculated by using the Kaplan-Meier method, and CSS comparisons were performed by using the logrank test. The results showed that TD count was an important prognostic factor and that the number of TDs was negatively correlated with the prognosis of CRC patients. We found that the prognostic value of one TD is equivalent to that of two mLNs based on the comparison of CSS rates. Accordingly, we proposed a novel N staging system by integrating the TD count into the N category with the ratio of TDs to mLNs being 1:2. There were no prognostic differences in patients with or without TDs in each novel N category. Weighing one TD as two mLNs in this novel TNM staging system is superior to the "N1c" classification in the 8th TNM staging system in evaluating the prognosis of CRC patients.