Multi-institutional Validation Study of the American Joint Commission on Cancer (8th Edition) Changes for T and N Staging in Patients With Pancreatic Adenocarcinoma.
Multi-institutional Validation Study of the American Joint Commission on Cancer (8th Edition) Changes for T and N Staging in Patients With Pancreatic Adenocarcinoma.
复制标题
美国癌症联合委员会多机构验证研究（第 8 版）胰腺癌患者 T 和 N 分期的变化。
DOI：
10.1097/sla.0000000000001763
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发表时间：
2017-01
影响因子：
9
通讯作者：
Mino-Kenudson M
中科院分区：
文献类型：
--
作者：
Allen PJ;Kuk D;Castillo CF;Basturk O;Wolfgang CL;Cameron JL;Lillemoe KD;Ferrone CR;Morales-Oyarvide V;He J;Weiss MJ;Hruban RH;Gönen M;Klimstra DS;Mino-Kenudson M
评估和验证胰腺癌T和N分期的第8版AJCC系统。研究人员质疑先前AJCC分期对胰腺腺癌的临床相关性和可重复性。在Memorial Sloan Kettering (MSK)，马萨诸塞州总医院（MGH）和约翰霍普金斯医院（JHH）的前瞻性数据库中查询了接受胰腺腺癌切除术的患者。患者接受了边缘阴性（R0）切除，谁曾接受过病理检查，包括。患者根据第七版AJCC标准以及拟议的第八版系统进行分期，该系统包括肿瘤大小(T)和淋巴结状态(N)的不同定义。数据集随机分为训练集和测试集。2318例患者符合纳入标准。在训练集（n= 1551）上进行递归划分，确定了肿瘤大小（<2.2cm,≥4.8cm）和节点状态（无阳性节点，1-3个阳性节点，≥4个阳性节点）在统计上合适的截止点，支持提议的第8版更改。按第7版定义分期为T3、N0的患者的中位生存期在不同机构之间存在差异（中位中心为1,24个月；中位中心为2,37个月；中位中心为3,29个月；p=0.054）。当患者按照第8版标准分为T3和N0时，没有观察到这种差异。在测试集上，分期和分期特异性结果（第7版）显示IIB亚组患者占优势（68%），分期特异性生存的一致性概率估计（CPE）为0.57。当用第8版标准进行评估时，没有哪个分期亚组的患者占多数，CPE为0.58。建议的第8版对T和N分类的修改在统计学上是有效的，并且可能允许更可重复的T分期系统。该系统还可以在不牺牲预后准确性的情况下更均匀地将患者分层。
To evaluate and validate the proposed 8th edition AJCC system for T and N staging of pancreatic adenocarcinoma. Investigators have questioned the clinical relevance and reproducibility of previous AJCC staging for pancreatic adenocarcinoma. Prospective databases at Memorial Sloan Kettering (MSK), Massachusetts General Hospital (MGH), and Johns Hopkins Hospital (JHH) were queried for patients who had undergone resection for pancreatic adenocarcinoma. Patients who underwent a margin-negative (R0) resection, and who had previously undergone pathologic review, were included. Patients were staged according to 7th edition AJCC criteria, as well as the proposed 8th edition system that includes different definitions of tumor size (T) and nodal status (N). The dataset was randomly split into training and test sets. 2,318 patients were identified who met inclusion criteria. Recursive partitioning on the training set (n=1,551) identified statistically appropriate cutoffs for tumor size (<2.2cm, ≥4.8cm,) and nodal status (no positive nodes, 1–3 positive nodes, ≥4 positive nodes) that supported the proposed 8th edition changes. Median survival in patients staged as T3, N0 by the 7th edition definitions was different between institutions (median Center 1, 24mo; Center 2, 37mo; Center 3, 29mo; p=0.054). This difference was not observed when patients were staged as T3, N0 by 8th edition criteria. Stage, and stage-specific outcome (7th edition), on the test set revealed a predominance of patients (68%) within the IIB subgroup, and a concordance probability estimate (CPE) of 0.57 for stage-specific survival. When assessed with 8th edition criteria, no stage subgroup had a majority of patients, and the CPE was 0.58. The proposed 8th edition changes for T and N classification were statistically valid and may allow a more reproducible system of T staging. This system also stratifies patients more evenly across stages without sacrificing prognostic accuracy.