The impact of tumor deposits on colonic adenocarcinoma AJCC TNM staging and outcome.
The impact of tumor deposits on colonic adenocarcinoma AJCC TNM staging and outcome.
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DOI：
10.1097/pas.0000000000000320
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发表时间：
2015-01
期刊：
影响因子：
--
通讯作者：
Frankel WL
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文献类型：
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作者：
Jin M;Roth R;Rock JB;Washington MK;Lehman A;Frankel WL
在不同版本的AJCC/TNM分期系统中，结肠腺癌中肿瘤沉积物（TD）的定义已被修改。研究表明，TD的存在与肿瘤晚期生长和预后不良有关。这些数据大多是在同时发生淋巴结转移的患者中获得的。关注TD对无淋巴结转移患者影响的报道有限。我们使用AJCC第5版、第6版和第7版的标准，回顾性地在10年内对所有右侧结肠腺癌进行了再切除。我们比较了各版本中被解释为LN和TD的肿瘤结节数量，并评估了TD定义改变引起的分期转移。然后，我们通过比较N1c患者与其他N类（N0, N1, N2）具有相似T和M状态的患者的5年总生存率来评估AJCC第7版中TD的临床意义。我们发现，与第5 /6版相比，第7版中每例被解释为LN的平均肿瘤结节数和LN阳性病例数显著减少；然而，与第5 /6版相比，第7版的TD和<12 LN病例数显著增加。然而，这些变化对最后阶段分组的影响微乎其微。我们的生存分析显示，N1c患者的生存率明显低于N0患者。危险比虽无统计学意义，但提示N1c组的生存期可能比N1组差，比N2组好。因此，我们得出结论，TD预测患者预后至少与LN阳性相似。
The definition of tumor deposits (TD) in colonic adenocarcinoma has been modified in different editions of AJCC/TNM staging system. Studies have shown that the presence of TD is associated with advanced tumor growth and poor prognosis. Most of these data were obtained in patients with simultaneous lymph node (LN) metastases. Reports focusing on the impact of TD in patients without LN metastasis are limited. We retrospectively restaged all right-sided colonic adenocarcinoma over a 10-year period using criteria from the 5th, 6th, and 7th AJCC edition. We compared the number of tumor nodule interpreted as LN and TD in each edition, and evaluated the stage migration caused by TD definition change. We then assessed clinical significance of TD in AJCC 7th edition by comparing 5-year overall survival of N1c patients vs. other N category (N0, N1, N2) patients with similar T and M status. We showed that average number of tumor nodule interpreted as LN per case and number of cases with positive LN were significantly decreased with 7th edition compared to 5th/6th; however, numbers of cases with TD and <12 LN were significantly increased with 7th edition compared to 5th/6th. These changes, however, resulted in minimal effects on the final stage grouping. Our survival analysis showed that N1c patients had significantly worse survival compared to N0 patients. Although not statistically significant, the hazard ratios indicated that N1c group might have worse survival than N1 group and better survival than N2 group. Therefore, we conclude that TD predict patient outcome at least similarly to positive LN.