TNM Staging of Colorectal Cancer Should be Reconsidered According to Weighting of the T Stage: Verification Based on a 25-Year Follow-Up.
TNM Staging of Colorectal Cancer Should be Reconsidered According to Weighting of the T Stage: Verification Based on a 25-Year Follow-Up.
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DOI：
10.1097/md.0000000000002711
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发表时间：
2016-02
期刊：
影响因子：
1.6
通讯作者：
Ding KF
中科院分区：
文献类型：
--
作者：
Li J;Yi CH;Hu YT;Li JS;Yuan Y;Zhang SZ;Zheng S;Ding KF
补充数字内容可在文本中现有的梯度单调性肿瘤，结直肠癌，转移分期系统是不令人满意的。我们提出的T+分期系统加强了T分期的权重。在这项研究中，T-plus分期系统的适用性进行了验证与中国结直肠癌中心的数据。回顾了1985年至2011年接受结直肠癌手术的2080例非转移性晚期癌症患者的T，N期病理和随访信息。使用总体和疾病特异性生存数据，比较第7版肿瘤、淋巴结、转移分期系统和T-plus分期系统的分期均匀性、区分度和梯度单调性。对于梯度单调性，T-plus分期系统对于结肠癌和直肠癌都是上级的。Kaplan-Meier生存曲线显示，T-plus分期系统可区分不同分期，相应的生存期与分期呈负相关。然而，在第7版肿瘤、淋巴结、转移分期系统中，IIIa期直肠癌的预后优于II期，I期结肠癌的预后优于II期。对于同一分期内的同质性和不同分期之间的区分，结直肠癌的2种分期系统相似，但T-plus系统明显优于结肠癌。T-plus分期系统提供了良好的梯度单调性。对于未来的结直肠癌分期系统，我们建议取代淋巴结状态作为标准，以区分结直肠癌II期和III期，更大的权重的T阶段。
Supplemental Digital Content is available in the text The gradient monotonicity of existing tumor, node, metastases staging systems for colorectal cancer is unsatisfactory. Our proposed T-plus staging system strengthens weighting of the T stage. In this study, applicability of the T-plus staging system was verified with data of a Chinese colorectal cancer center. Records of 2080 nonmetastatic, advanced cancer patients undergoing colorectal cancer surgery from 1985 to 2011 were reviewed for T, N stage pathology and follow-up information. Using overall and disease-specific survival data, the 7th edition tumor, node, metastases staging system and the T-plus staging system were compared for stage homogeneity and discrimination and gradient monotonicity. For gradient monotonicity, the T-plus staging system was superior for both colon and rectal cancer. With Kaplan–Meier survival curves, the T-plus staging system discriminated among different stages, and the corresponding survival was inversely associated with the stage. However, for the 7th edition tumor, node, metastases staging system, stage IIIa had a better prognosis than stage II for rectal cancer and stage I for colon cancer. For homogeneity within the same stage and discrimination between different stages, the 2 staging systems were similar for colorectal cancer, but the T-plus system was clearly better for colon cancer. The T-plus staging system provides good gradient monotonicity. For future colorectal cancer staging systems, we propose replacement of lymph node status as the criterion to discriminate colorectal cancer stage II and stage III with greater weighting of the T stage.