Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification
Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification
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日本直肠癌分期系统的验证，重点关注与 TNM 分期的差异
DOI：
10.1007/s00595-020-02024-4
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发表时间：
2020
期刊：
影响因子：
2.5
通讯作者：
Wakai Toshifumi
中科院分区：
文献类型：
--
作者：
Arabiki Michiru;Shimada Yoshifumi;Nakano Mae;Tanaka Kana;Oyanagi Hidehito;Nakano Masato;Ling Yiwei;Okuda Shujiro;Takii Yasumasa;Wakai Toshifumi
第九届日本结直肠癌分类（9th JSCCR）与第八届日本结直肠癌TNM分类（8th AJCC）有两个主要区别：第一，将主要或侧方淋巴结转移分类为jN3;第二，将肿瘤结节（ND）作为淋巴结转移处理。在这项研究中，我们验证了第9 JSCCR直肠癌，专注于与第8 AJCC.MethodsThis回顾性分析涉及212例I-III期直肠癌患者的差异。使用整体切片评价ND。我们评估了每个分期系统的无复发生存，并比较了不同的分期系统使用赤池信息标准（AIC）和Harrell的一致性指数（C-指数）的预后意义。212例患者中有79例（37%）检测到ND。在第9届JSCCR中观察到最佳风险分层把握度（AIC，759; c指数，0.708）与第7届JSCCR相比（AIC，771; c-index，0.681），第8届JSCCR（AIC，768; c-index，0.696）和第八届AJCC（AIC，766; c-index，0.691）。结论第9版JSCCR包含了jN3和ND的概念，可用于直肠癌的危险分层，有助于对后续管理和辅助治疗做出准确的决策。
PurposeThe 9th Japanese Classification of Colorectal Cancer (9th JSCCR) has two main differences from the TNM classification (8th AJCC): first, main or lateral lymph node metastasis is classified as jN3; second, tumor nodules (ND) are treated as lymph node metastasis. In this study, we verified the 9th JSCCR for rectal cancer, focusing on the differences with the 8th AJCC.MethodsThis retrospective analysis involved 212 patients with stage I-III rectal cancer. ND was evaluated using whole-mount sections. We evaluated the relapse-free survival of each staging system, and compared the prognostic significance of the different staging systems using the Akaike information criterion (AIC) and Harrell’s concordance index (c-index).ResultsMain or lateral lymph node metastasis was detected in nine of 212 (4%) patients. ND was detected in 79 of 212 (37%) patients. The best risk stratification power was observed in the 9th JSCCR (AIC, 759; c-index, 0.708) compared with the 7th JSCCR (AIC, 771; c-index, 0.681), 8th JSCCR (AIC, 768; c-index, 0.696), and the 8th AJCC (AIC, 766; c-index, 0.691).ConclusionsThe 9th JSCCR, which includes the concepts of jN3 and ND, is useful for the risk stratification of rectal cancer, and the contributes to precise decision-making for follow-up management and adjuvant therapy.
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