Comparison of a Lymph Node Ratio-Based Staging System With the 7th AJCC System for Gastric Cancer Analysis of 18,043 Patients From the SEER Database
Comparison of a Lymph Node Ratio-Based Staging System With the 7th AJCC System for Gastric Cancer Analysis of 18,043 Patients From the SEER Database
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DOI：
10.1097/sla.0b013e31824857e2
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发表时间：
2012-03-01
影响因子：
9
通讯作者：
Yoon, Sam S.
中科院分区：
文献类型：
--
作者：
Wang, Jiping;Dang, Ping;Yoon, Sam S.
目的：美国癌症联合委员会（AJCC）的胃癌分期系统基于转移性淋巴结的绝对数量的N状态，无论检查的淋巴结数量如何。我们研究了一个修改后的分期系统，利用节点比（Nr），转移到检查nodes.Methods的比例：共18,043胃癌患者进行胃切除术从美国监测，流行病学和最终结果（SEER）数据库。将训练集分为5个Nr组，并构建TNRM分期系统。中位生存期和总生存期，第7版AJCC和TNrM分期系统的基础上，进行了比较，并在一个验证set.Results：中位数检查节点为10至11重复分析。对于训练集，当亚组为15个或更少与超过15个检查的节点时，所有5个AJCC N类别的总生存期显著不同，但无论5个Nr类别中的4个中检查的节点数量如何，总生存期相似。7个AJCC分期在亚组之间的总生存率有统计学差异，而只有1个TNrM分期在亚组之间的总生存率有统计学差异。当误分类被定义为任何亚组中的中位生存期落在该组总体中位生存期的95%置信区间之外时，AJCC分期误分类57%的患者，TNrM分期仅误分类12%。在validationset.Conclusions：AJCC系统分类SEER胃癌患者的阶段，亚组往往有很大的差异，在生存期。对于接受有限淋巴结分析的患者，所提出的TNrM系统可以更准确地预测生存率。
Objectives: The American Joint Committee on Cancer (AJCC) staging system for gastric cancer bases N status on absolute number of metastatic nodes, regardless of the number of examined nodes. We examined a modified staging system utilizing node ratio (Nr), the ratio of metastatic to examined nodes.Methods: A total of 18,043 gastric cancer patients who underwent gastrectomy were identified from the US Surveillance, Epidemiology, and End Results (SEER) database. A training set was divided into 5 Nr groups, and a TNrM staging system was constructed. Median survival and overall survival, based on 7th edition AJCC and TNrM staging systems, were compared, and the analysis was repeated in a validation set.Results: Median examined nodes were 10 to 11. For the training set, overall survival for all 5 AJCC N categories was significantly different when sub-grouped into 15 or fewer versus more than 15 examined nodes, but overall survival was similar regardless of the number of examined nodes in 4 of 5 Nr categories. Seven AJCC stages had statistically different overall survival between subgroups, whereas only 1 TNrM stage had statistically different overall survival between subgroups. When misclassification was defined as any subgroup in which median survival fell outside the 95% confidence interval of the group's overall median survival, AJCC staging misclassified 57% of patients and TNrM staging misclassified only 12%. Similar results were found in the validation set.Conclusions: The AJCC system classifies SEER gastric cancer patients into stages in which subgroups often have wide variations in survival. For patients undergoing limited lymph node analysis, the proposed TNrM system may predict survival more accurately.