Improving the Accuracy of TNM Staging in Esophageal Cancer: A Pathological Review of Resected Specimens
Improving the Accuracy of TNM Staging in Esophageal Cancer: A Pathological Review of Resected Specimens
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DOI：
10.1245/s10434-008-0155-0
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发表时间：
2008-12-01
影响因子：
3.7
通讯作者：
Devitt, Peter G.
中科院分区：
文献类型：
--
作者：
Thompson, Sarah K.;Ruszkiewicz, Andrew R.;Devitt, Peter G.
背景：国际抗癌联盟 (UICC) 第六版食管癌 TNM 分期系统存在争议。纳入转移性淋巴结数量和包膜外淋巴结侵犯等附加信息可能会改善当前的分期系统并优化患者治疗。方法：从前瞻性数据库中识别出 1997 年至 2007 年间阿德莱德接受食管癌切除术的所有患者。然后，两名独立观察者重新检查了原始切除的所有病理切片。进行单变量和多变量分析以确定显着的预后因素。评估其他预后因素的拟合优度和准确性，并根据此信息修改分期系统。结果：有 240 名患者（平均年龄，62 岁）符合纳入标准。 5年总生存率为36%（中位24个月）。仅发现组织学分级和精确的 pN 分期是独立的预后因素，可用于改善当前的 TNM 分期。将 pN 分期细分为三组（0、1-2 和 > 2 个阳性淋巴结），显示所有三组之间的 5 年生存率存在显着差异：分别为 53% vs 27% vs 6% (P < .01)。对于接受新辅助治疗和手术的患者 (n = 116) 和仅接受手术的患者 (n = 124)，最佳分期模型是相同的。结论：结合了精确的 pN 分期和组织学分级的分期模型似乎比当前的 UICC-TNM 分期系统更准确。该分期模型仍然适用于接受新辅助治疗的患者。
Background: Controversy exists over the Sixth Edition of the International Union Against Cancer (UICC) TNM staging system for esophageal cancer. Inclusion of additional information such as the number of metastatic lymph nodes and extracapsular lymph node invasion may improve the current staging system and lead to optimization of patient treatment.Methods: All patients in Adelaide who underwent resection for esophageal cancer between 1997 and 2007 were identified from a prospective database. Two independent observers then reexamined all pathology slides from the original resection. Univariate and multivariate analysis was performed to identify significant prognostic factors. The goodness of fit and accuracy of additional prognostic factors were assessed, and the staging system was modified according to this information.Results: There were 240 patients (mean age, 62 years) who met the inclusion criteria. The 5-year overall survival rate was 36% (median, 24 months). Only histological grade and a refined pN stage were found to be independent prognostic factors that could then be used to improve current TNM staging. Subdivision of pN stage into three groups (0, 1-2, and > 2 positive nodes) showed significant differences in 5-year survival between all three groups: 53% vs 27% vs 6%, respectively (P < .01). The optimal staging model was the same for patients who received neoadjuvant therapy and surgery (n = 116), and those who underwent surgery alone (n = 124).Conclusion: A staging model that incorporates a refined pN stage and histological grade appears to be more accurate than the current UICC-TNM staging system. This staging model is still applicable in patients who receive neoadjuvant therapy.