Comparison of the 6th and 7th Editions of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System in Patients With Resected Esophageal Carcinoma
Comparison of the 6th and 7th Editions of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System in Patients With Resected Esophageal Carcinoma
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DOI：
10.1016/j.athoracsur.2010.01.017
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发表时间：
2010-04-01
影响因子：
4.6
通讯作者：
Hsu, Wen-Hu
中科院分区：
文献类型：
--
作者：
Hsu, Po-Kuei;Wu, Yu-Chung;Hsu, Wen-Hu
背景美国癌症联合委员会（AJCC）第7版TNM分期系统最近出版。我们的目的是评估其预测能力，并比较第6版和第7版AJCC食管癌TNM分期系统的性能。共纳入1995年至2006年间接受初次手术切除的392例食管鳞状细胞癌患者。使用第6版和第7版分期系统对患者进行分期。采用考克斯回归模型进行生存分析。采用线性趋势卡方检验（2）、似然比卡方检验（2）统计量和赤池信息准则计算比较两种分期系统的同质性、区分能力和梯度单调性。整个队列的总体5年生存率为27.1%。多因素分析显示，女性、根据第7版分期系统定义的“T”、“N”和“M”分类是独立的预后因素。但组织学分级和肿瘤部位对患者生存率无显著影响。第7版分期系统具有最高的线性趋势chi（2）和似然比chi（2）评分。与第6版相比，第7版的Akaike信息标准值也更小，代表了最佳的预后分层。第7版AJCC TNM分期系统的优势在于“N”和“M”分类的新描述符。然而，我们并没有发现组织学分级和肿瘤位置是我们队列中重要的预后因素。总体而言，第7版AJCC TNM分期系统的性能比上一版更好。
Background. The 7th edition American Joint Committee on Cancer tumor-nodes-metastasis (AJCC TNM) staging system was published recently. We aim to evaluate its predictive ability and to compare the performance of the 6th and 7th editions of the AJCC TNM staging systems in esophageal cancer.Methods. A total of 392 esophageal squamous cell carcinoma patients receiving primary surgical resection between 1995 and 2006 were included. Patients were staged using the 6th and 7th edition staging systems. Survival analysis was performed with a Cox regression model. The homogeneity, discriminatory ability, and monotonicity of gradients of two staging systems were compared using linear trend chi(2), likelihood ratio chi(2) statistics, and Akaike information criterion calculation.Results. The overall five-year survival rate for the entire cohort was 27.1%. Female gender, "T," "N," and "M" classifications according to the 7th edition staging system definition were independent prognostic factors in multivariate analysis. But histology grade and cancer location had no significant influence on patient survival. The 7th edition staging system has the highest linear trend chi(2) and likelihood ratio chi(2) scores. Compared with the 6th edition, the 7th edition staging system also has a smaller Akaike information criterion value, which represented the optimum prognostic stratification.Conclusions. The strength of the 7th edition AJCC TNM staging system is the new descriptors for "N" and "M" classifications. However, we did not find histologic grade and cancer location to be significant prognostic factors in our cohort. Overall, the 7th edition AJCC TNM staging system has better performance than the previous edition.