Validation of the American Joint Commission on Cancer (AJCC) 8th Edition Staging System for Patients with Pancreatic Adenocarcinoma: A Surveillance, Epidemiology and End Results (SEER) Analysis
Validation of the American Joint Commission on Cancer (AJCC) 8th Edition Staging System for Patients with Pancreatic Adenocarcinoma: A Surveillance, Epidemiology and End Results (SEER) Analysis
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DOI：
10.1245/s10434-017-5810-x
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发表时间：
2017-07-01
影响因子：
3.7
通讯作者：
Nathan, Hari
中科院分区：
文献类型：
--
作者：
Kamarajah, Sivesh K.;Burns, William R.;Nathan, Hari
第8版胰腺癌AJCC分期系统合并了几项重大变化。本研究旨在评估这一分期系统，并评估其相对于第7版AJCC分期系统的优势和劣势。使用监测、流行病学和最终结果(SEER)数据库(2004-2013年)，确定8960名接受手术切除的非转移性胰腺癌患者。使用Kaplan-Meier方法估计总体生存时间，并使用对数等级检验进行比较。计算一致性指数(c-index)来评价两种分期系统的区分力。用COX比例风险模型分析T和N分级对总生存率的影响。AJCC第8版分期系统的c指数[0.60；95%可信区间(CI)0.59~0.61]与第7版AJCC分期系统的c指数(0.59；95%CI，0.58~0.60)相当。对每个N分类系统的分层分析表明，随着结节受累的增加，T分类对总体生存率的影响逐渐减小。相应的c指数为N0的0.58(95%CI，0.55~0.60)，N1的0.53(95%CI，0.51~0.55)，N2的0.53(95%CI，0.50~0.56)。这是AJCC第8版胰腺癌分期系统的首次大规模验证。修订后的系统提供了类似于第7版系统的歧视。然而，第8版的系统允许根据结节受累的程度对切除肿瘤的患者进行更精细的分层。
The 8th edition of the AJCC staging system for pancreatic cancer incorporated several significant changes. This study sought to evaluate this staging system and assess its strengths and weaknesses relative to the 7th edition AJCC staging system.Using the Surveillance, Epidemiology and End Results (SEER) database (2004-2013), 8960 patients undergoing surgical resection for non-metastatic pancreatic adenocarcinoma were identified. Overall survival was estimated using the Kaplan-Meier method and compared using log-rank tests. Concordance indices (c-index) were calculated to evaluate the discriminatory power of both staging systems. The Cox proportional hazards model was used to determine the impact of T and N classification on overall survival.The c-index for the AJCC 8th staging system [0.60; 95% confidence interval (CI), 0.59-0.61] was comparable with that for the 7th edition AJCC staging system (0.59; 95% CI, 0.58-0.60). Stratified analyses for each N classification system demonstrated a diminishing impact of T classification on overall survival with increasing nodal involvement. The corresponding c-indices were 0.58 (95% CI, 0.55-0.60) for N0, 0.53 (95% CI, 0.51-0.55) for N1, and 0.53 (95% CI, 0.50-0.56) for N2 classification.This is the first large-scale validation of the AJCC 8th edition staging system for pancreatic cancer. The revised system provides discrimination similar to that of the 7th-edition system. However, the 8th-edition system allows for finer stratification of patients with resected tumors according to extent of nodal involvement.