Cancer of the Esophagus and Esophagogastric Junction Data-Driven Staging for the Seventh Edition of the American Joint Committee on Cancer/International Union Against Cancer Cancer Staging Manuals
Cancer of the Esophagus and Esophagogastric Junction Data-Driven Staging for the Seventh Edition of the American Joint Committee on Cancer/International Union Against Cancer Cancer Staging Manuals
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DOI：
10.1002/cncr.25146
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发表时间：
2010-08-15
期刊：
影响因子：
6.2
通讯作者：
Blackstone, Eugene H.
中科院分区：
文献类型：
--
作者：
Rice, Thomas W.;Rusch, Valerie W.;Blackstone, Eugene H.
背景：以前美国癌症联合委员会/国际抗癌联合会(AJCC/UICC)对食道癌的分期没有数据驱动，也没有与胃癌协调一致。应AJCC的要求，汇集了来自三大洲的全球数据，以开发AJCC/UICC癌症分期手册第七版的数据驱动的协调食道分期。方法：对4627例单纯手术治疗的食管胃交界部癌患者的全因死亡率进行分析，采用新的随机森林方法，得出生存时间单调递减、独特、均匀的分期。结果：对于淋巴结阴性的pNOMO癌，风险调整后的5年生存率主要取决于病理肿瘤分类(PT)，但受组织病理学细胞类型、组织学分级和部位的影响。对于淋巴结阳性、PN+MO的癌症，癌症阳性淋巴结的数量(一种新的PN分类)决定了生存率。由此产生的阶段分组偏离了技术需求管理的简单、合乎逻辑的安排。I期和II期腺癌的分期基于PT、PN和组织学分级；鳞癌的分期基于PT、PN、组织学分级和位置。III期的组织病理学细胞类型相似，仅以PT和PN为基础。根据定义，0期和IV期分别被归类为原位肿瘤(Tis)(高度不典型增生)和PM1。结论：食管胃交界癌患者的预后取决于TNM分类和非解剖学因素的复杂相互作用，包括组织病理细胞类型、组织学分级和肿瘤部位。这些特征被纳入AJCC/UICC第七版癌症分期手册的数据驱动的癌症分期中。癌症2010；116：3763-73。(C)2070年美国癌症协会
BACKGROUND: Previous American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) stage groupings for esophageal cancer have not been data driven or harmonized with stomach cancer. At the request of the AJCC, worldwide data from 3 continents were assembled to develop data-driven, harmonized esophageal staging for the seventh edition of the AJCC/UICC cancer staging manuals. METHODS: All-cause mortality among 4627 patients with esophageal and esophagogastric junction cancer who underwent surgery alone (no pre-operative or postoperative adjuvant therapy) was analyzed by using novel random forest methodology to produce stage groups for which survival was monotonically decreasing, distinctive, and homogeneous. RESULTS: For lymph node-negative pNOMO cancers, risk-adjusted 5-year survival was dominated by pathologic tumor classification (pT) but was modulated by histopathologic cell type, histologic grade, and location. For lymph node-positive, pN+MO cancers, the number of cancer-positive lymph nodes (a new pN classification) dominated survival. Resulting stage groupings departed from a simple, logical arrangement of TNM. Stage groupings for stage I and II adenocarcinoma were based on pT, pN, and histologic grade; and groupings for squamous cell carcinoma were based on pT, pN, histologic grade, and location. Stage III was similar for histopathologic cell types and was based only on pT and pN. Stage 0 and stage IV, by definition, were categorized as tumor in situ (Tis) (high-grade dysplasia) and pM1, respectively. CONCLUSIONS: The prognosis for patients with esophageal and esophagogastric junction cancer depends on the complex interplay of TNM classifications as well as nonanatomic factors, including histopathologic cell type, histologic grade, and cancer location. These features were incorporated into a data-driven staging of these cancers for the seventh edition of the AJCC/UICC cancer staging manuals. Cancer 2010;116:3763-73. (C) 2070 American Cancer Society