Comparison of the prognostic value of the 6th and 7th editions of the Union for International Cancer Control TNM staging system in patients with lower esophageal cancer undergoing neoadjuvant chemotherapy followed by surgery
Comparison of the prognostic value of the 6th and 7th editions of the Union for International Cancer Control TNM staging system in patients with lower esophageal cancer undergoing neoadjuvant chemotherapy followed by surgery
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DOI：
10.1111/j.1442-2050.2012.01350.x
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发表时间：
2013-02-01
影响因子：
2.6
通讯作者：
Grabsch, H. I.
中科院分区：
文献类型：
--
作者：
Mehta, S. P.;Jose, P.;Grabsch, H. I.
食管癌根据国际癌症控制联盟（UICC）TNM分期系统进行分类。UICC TNM分期系统第7版于2009年出版。这是第一项比较TNM第6版和第7版对食管癌患者化疗后手术的预后价值的研究。从两个转诊中心回顾性选择了243例食管癌患者。所有患者术前均接受化疗。根据TNM第7版检索切除标本的组织学数据并重新分级。绘制肿瘤浸润深度（ypT）、淋巴结状态（ypN）和ypTNM分期的疾病特异性生存曲线，然后进行比较。术后中位随访时间为2.5年（范围0.29年）。使用对数秩方法的生存分析显示，ypT4疾病和ypT3疾病之间的生存率存在显著差异（P= 0.003），但无论使用哪种TNM版本，ypT0、ypT1、ypT2和ypT3类别之间均无差异。ypN0与ypN1（TNM第6版和第7版，P= 0.001），ypN2与ypN3（TNM第7版，P= 0.004）之间生存概率差异有统计学意义，而ypN1与ypN2（TNM第7版，P= 0.89）之间生存概率差异无统计学意义。TNM第6版和第7版T分期均不能提供准确的生存概率分层。然而，第7版的优势是在淋巴结受累患者的生存分层中引入了第三级。
Carcinoma of the esophagus is classified according to the Union for International Cancer Control (UICC) TNM staging system. The 7th edition of the UICC TNM staging system was published in 2009. This is the first study to compare the prognostic value of the TNM 6th and 7th editions in patients with esophageal carcinoma treated with chemotherapy followed by surgery. Two hundred forty-three patients with esophageal carcinoma were retrospectively selected from two referral centers. All patients received chemotherapy before surgery. Histopathologic data from the resection specimens were retrieved and restaged according to the TNM 7th edition. Disease-specific survival curves were plotted for depth of tumor invasion (ypT), lymph node status (ypN), and ypTNM stage and then compared. Median follow-up after surgery was 2.5 years (range 0.29 years). Survival analysis using the log-rank method revealed that there was a significant difference in survival between ypT4 disease and ypT3 disease (P= 0.003), but no difference between ypT0, ypT1, ypT2, and ypT3 categories irrespective of TNM edition used. Survival probability was significantly different between ypN0 and ypN1 (P= 0.001 for TNM 6th and 7th edition), as well as ypN2 and ypN3 (TNM 7th edition, P= 0.004), but not between ypN1 and ypN2 (TNM 7th edition, P= 0.89). Neither the TNM 6th nor 7th edition T staging provides accurate survival probability stratification. However, the advantage of the 7th edition is the introduction of a third tier in survival stratification for patients with nodal involvement.