Worldwide Esophageal Cancer Collaboration: clinical staging data.
Worldwide Esophageal Cancer Collaboration: clinical staging data.
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DOI：
10.1111/dote.12493
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发表时间：
2016-10
期刊：
影响因子：
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通讯作者：
Blackstone EH
中科院分区：
文献类型：
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作者：
Rice TW;Apperson-Hansen C;DiPaola LM;Semple ME;Lerut TE;Orringer MB;Chen LQ;Hofstetter WL;Smithers BM;Rusch VW;Wijnhoven BP;Chen KN;Davies AR;D'Journo XB;Kesler KA;Luketich JD;Ferguson MK;Räsänen JV;van Hillegersberg R;Fang W;Durand L;Allum WH;Cecconello I;Cerfolio RJ;Pera M;Griffin SM;Burger R;Liu JF;Allen MS;Law S;Watson TJ;Darling GE;Scott WJ;Duranceau A;Denlinger CE;Schipper PH;Ishwaran H;Blackstone EH
为了解决食管癌临床分期（cTNM）是否与单独食管癌切除术后病理分期（pTNM）具有相同预后意义的不确定性，我们报告了来自世界食管癌合作组织（WECC）的临床分期患者的数据-患者特征，癌症类别和非风险调整生存率的简单描述。来自六大洲的33个机构提交了使用具有标准定义的变量的数据：人口统计学、合并症、临床癌症类别和首次管理决策的全因死亡率。在22123例临床分期患者中，8156例为鳞状细胞癌，13814例为腺癌，116例为腺鳞癌，37例为未分化癌。患者为年龄较大（62岁）男性（80%），体重指数正常（18.5-25 mg/kg2, 47%），体重减轻（2.4±7.8 kg）， ECOG表现0-1状态（67%），吸烟史（67%）。肿瘤为cT1（12%）、cT2（22%）、cT3（56%）、cNO（44%）、cMO（95%）和cG2-G3 (89%)；大多数累及食管远端（73%）。鳞状细胞癌的非风险调整生存率在早期cT或cN中没有明显差异；对于腺癌，早期与晚期cT、cNO与cN+的差异是显著的。早期癌症患者的生存期较差，而晚期癌症患者的生存期优于基于先前WECC病理数据的等效病理分类的预期。因此，临床和病理分类不具有预后意义。这使得基于临床的治疗决策变得困难，治疗前的预测也不准确。这些数据将成为第8版癌症分期手册的基础，根据患者特征、癌症类别和治疗特征进行风险调整，并应指导第9版数据收集。
To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data—simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival—for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5–25 mg/kg2, 47%), little weight loss (2.4 ± 7.8 kg), 0–1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cNO (44%), cMO (95%), and cG2–G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cNO versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.