Comparison Between Established and the Worldwide Esophageal Cancer Collaboration Staging Systems
Comparison Between Established and the Worldwide Esophageal Cancer Collaboration Staging Systems
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DOI：
10.1016/j.athoracsur.2010.02.048
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发表时间：
2010-06-01
影响因子：
4.6
通讯作者：
Swisher, Stephen G.
中科院分区：
文献类型：
--
作者：
Gaur, Puja;Hofstetter, Wayne L.;Swisher, Stephen G.
背景关于胃食管连接部腺癌（GEJA）患者的最佳分期系统存在争议。全球食管癌协作组（WECC）组织了一个多机构数据库，从中组织了一个新的食管分期系统。我们使用一个单一的机构的经验来验证的假设，即WECC系统更准确地预测生存GEJA患者比美国癌症联合委员会第6版食管和胃系统。我们回顾了1990年至2007年间449例GEJA患者（Siewert I-III）接受新辅助治疗，随后接受手术或单纯手术治疗。盲态统计学家对每个分期系统预测生存率的能力进行了头对头比较。对仅接受手术的患者（n = 176）进行了亚组分析。这三个系统都能预测GEJA患者的生存率。然而，贝叶斯变量选择模型发现，WECC系统优于美国癌症联合委员会食管和胃系统（概率分别为0.99和0.98）。亚组分析提示WECC分期也是预测单纯手术患者生存率的最佳方法。虽然食管分期系统比胃分期系统更好地预测生存，但WECC系统可能是GEJA切除患者生存的最有利的单系统预测因子。正如WECC系统所建议的，将阳性淋巴结的数量纳入分期系统可能在预测生存方面具有优势。(Ann Thorac Surg 2010; 89：1797 - 804）（C）2010年，胸外科医师协会
Background. Controversy exists regarding the optimal staging system for patients with gastroesophageal junction adenocarcinoma (GEJA). The Worldwide Esophageal Cancer Collaboration (WECC) has organized a multi-institutional database from which a novel esophageal staging system has been organized. We used a single institution experience to validate the hypothesis that the WECC system more accurately predicts survival in GEJA patients than both the American Joint Commission on Cancer 6th edition esophageal and gastric systems.Methods. We reviewed 449 GEJA patients (Siewert I-III) treated with neoadjuvant therapy followed by surgery or surgery-alone between 1990 and 2007. A blinded statistician performed a head-to-head comparison regarding the ability of each staging system to predict survival. A subgroup analysis of patients who underwent surgery only (n = 176) was also performed.Results. All three systems predicted survival of patients with GEJA. However, a Bayesian variable selection model found that the WECC system was better than both American Joint Commission on Cancer esophageal and gastric systems (probability 0.99 and 0.98, respectively). Subset analysis suggested that the WECC staging was also optimum for predicting survival in surgery-alone patients.Conclusions. While the esophageal staging system is better at predicting survival than the gastric staging system, the WECC system may be the most favorable single-system predictor of survival for patients with resected GEJA. As suggested by the WECC system, incorporating the number of positive lymph nodes within the staging system may present an advantage in predicting survival. (Ann Thorac Surg 2010; 89: 1797-804) (C) 2010 by The Society of Thoracic Surgeons