8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice
8th edition AJCC/UICC staging of cancers of the esophagus and esophagogastric junction: application to clinical practice
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DOI：
10.21037/acs.2017.03.14
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发表时间：
2017-03-01
影响因子：
3.1
通讯作者：
Blackstone, Eugene H.
中科院分区：
文献类型：
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作者：
Rice, Thomas W.;Patil, Deepa T.;Blackstone, Eugene H.
第8版美国癌症联合委员会（AJCC）食管和食管胃交界处（EGJ）上皮癌分期提出了临床（cTNM）、病理（pTNM）和新辅助治疗后（ypTNM）分期组的单独分类。组织学细胞类型显著影响临床和病理分期患者的存活率，需要对每种细胞类型进行单独分组，但ypTNM分组对两种细胞类型是相同的。临床类别，通常通过成像获得最少的组织学信息，受到每种方法分辨率的限制。应认识到临床分期方法的优点和缺点。补充细胞学或组织病理学结果可能会增加成像和援助最初的治疗决策。然而，与pTNM相比，使用临床分期组的精确化仍然是粗糙和不准确的。随着新辅助治疗取代单纯食管切除术，病理分期对晚期癌症失去了意义。然而，它仍然与早期癌症相关，并作为分期和生存参考点。虽然病理分期可以帮助决策，其用于指导术后辅助治疗有待更有效的治疗。使用病理分期组进行预测是所有分类中最精确的。新辅助治疗后分期（Postneoadjuvant staging，ypTNM）由AJCC引入，但未被国际癌症控制联盟（Union for International Cancer Control，UICC）采用。这种增加的驱动因素包括缺乏新辅助治疗后状态（ypT 0 N 0 - 3 M0和ypTisN 0 - 3 M0）特有的等同病理（pTNM）类别，不同的阶段组组成，以及明显不同的生存特征。因此，新辅助治疗对接受新辅助治疗的患者具有特异性。ypTNM分类在额外治疗决策中的作用目前有限。精确的癌症护理进步是必要的，这些信息是临床有用的。
The 8th edition of the American Joint Committee on Cancer (AJCC) staging of epithelial cancers of the esophagus and esophagogastric junction (EGJ) presents separate classifications for clinical (cTNM), pathologic (pTNM), and postneoadjuvant (ypTNM) stage groups. Histopathologic cell type markedly affects survival of clinically and pathologically staged patients, requiring separate groupings for each cell type, but ypTNM groupings are identical for both cell types. Clinical categories, typically obtained by imaging with minimal histologic information, are limited by resolution of each method. Strengths and shortcomings of clinical staging methods should be recognized. Complementary cytology or histopathology findings may augment imaging and aid initial treatment decision-making. However, prognostication using clinical stage groups remains coarse and inaccurate compared with pTNM. Pathologic staging is losing its relevance for advanced-stage cancer as neoadjuvant therapy replaces esophagectomy alone. However, it remains relevant for early-stage cancers and as a staging and survival reference point. Although pathologic stage could facilitate decision-making, its use to direct postoperative adjuvant therapy awaits more effective treatment. Prognostication using pathologic stage groups is the most refined of all classifications. Postneoadjuvant staging (ypTNM) is introduced by the AJCC but not adopted by the Union for International Cancer Control (UICC). Drivers of this addition include absence of equivalent pathologic (pTNM) categories for categories peculiar to the postneoadjuvant state (ypT0N0-3M0 and ypTisN0-3M0), dissimilar stage group compositions, and markedly different survival profiles. Thus, prognostication is specific for patients undergoing neoadjuvant therapy. The role of ypTNM classification in additional treatment decision-making is currently limited. Precision cancer care advances are necessary for this information to be clinically useful.