Clinical Utility of ypTNM Stage Grouping in the 8th Edition of the American Joint Committee on Cancer TNM Staging System for Esophageal Squamous Cell Carcinoma
Clinical Utility of ypTNM Stage Grouping in the 8th Edition of the American Joint Committee on Cancer TNM Staging System for Esophageal Squamous Cell Carcinoma
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DOI：
10.1245/s10434-020-09181-3
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发表时间：
2020-10-06
影响因子：
3.7
通讯作者：
Wakai, Toshifumi
中科院分区：
文献类型：
--
作者：
Sudo, Natsuru;Ichikawa, Hiroshi;Wakai, Toshifumi
第8版美国癌症联合委员会（AJCC）TNM分期系统为食管癌患者提供了一个特定的“ypTNM”分期分组。目的探讨AJCC第8版ypTNM分期对食管鳞癌的临床应用价值。方法我们纳入了2005年6月至2011年12月期间接受新辅助顺铂联合5-氟尿嘧啶（CF）治疗后接受手术治疗的152例ESCC患者。根据AJCC第7版和第8版对ypStage进行评价。比较两个版本之间疾病特异性生存期（DSS）和总生存期（OS）的预测性能。采用单因素和多因素分析评估ypTNM分期分组的预后意义。结果AJCC第7版至第8版的修订与96例患者（63.2%）的ypStage变化相关。AJCC第8版在DSS方面的预测性能优于第7版（Akaike信息标准[AIC] 499 vs. 513;贝叶斯信息标准[BIC] 505 vs. 519;一致性指数[C-index] 0.725 vs. 0.679）和OS（AIC 662对674; BIC 669对681; C指数0.662对0.622）。结论AJCC第8版ypTNM分期分组对DSS和OS的预测能力优于AJCC第7版。第8版中的ypStage是新辅助CF治疗后接受手术的ESCC患者最可靠的预后因素。
Background The 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system provided a specific 'ypTNM' stage grouping for patients with esophageal cancer. Objective This study aimed to evaluate the clinical utility of the AJCC 8th edition ypTNM stage grouping for patients with esophageal squamous cell carcinoma (ESCC). Methods We enrolled 152 patients with ESCC who underwent surgery after neoadjuvant cisplatin plus 5-fluorouracil (CF) therapy between June 2005 and December 2011. ypStage was evaluated according to the AJCC 7th and 8th editions. Predictive performance for disease-specific survival (DSS) and overall survival (OS) was compared between both editions. The prognostic significance of ypTNM stage grouping was evaluated using univariate and multivariate analyses. Results Revision of the AJCC 7th edition to the 8th edition was associated with a change in ypStage in 96 patients (63.2%). The AJCC 8th edition revealed a better predictive performance than the 7th edition in terms of DSS (Akaike's information criterion [AIC] 499 vs. 513; Bayesian information criterion [BIC] 505 versus 519; concordance index [C-index] 0.725 versus 0.679) and OS (AIC 662 vs. 674; BIC 669 vs. 681; C-index 0.662 vs. 0.622). On univariate and multivariate analyses, ypStage in the 8th edition was an independent prognostic factor for both DSS and OS. Conclusions ypTNM stage grouping in the AJCC 8th edition provided a better predictive performance for DSS and OS than that in the 7th edition. ypStage in the 8th edition was the most reliable prognostic factor for ESCC patients who underwent surgery after neoadjuvant CF therapy.