The revised American Joint Committee on Cancer staging system (7th edition) improves prognostic stratification after minimally invasive esophagectomy for esophagogastric adenocarcinoma

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• 作者：Haris Zahoor ; M.D.^a ; James D. Luketich ; M.D.^b ; Benny Weksler ; M.D.^c ; Daniel G. Winger ; M.S.^d ; Neil A. Christie ; M.D.^b ; Ryan M. Levy ; M.D.^b ; Michael K. Gibson ; M.D. ; Ph.D.^e ; Jon M. Davison ; M.D.^f ; Katie S. Nason ; M.D. ; M.P.H.^b ; ^{nasonks@upmc.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Staging ; Neoplasm ; Esophageal neoplasms ; Adenocarcinoma ; Esophagectomy ; Survival
• 刊名：The American Journal of Surgery
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：210
• 期：4
• 页码：610-617
• 全文大小：626 K

文摘

Staging for esophagogastric adenocarcinoma lacked sufficient prognostic accuracy and was revised. We compared survival prognostication between American Joint Committee on Cancer (AJCC) 6th and 7th editions.

absSec_2">Methods

abspara0015">We abstracted data for 836 patients who underwent minimally invasive esophagectomy for esophagogastric adenocarcinoma (n = 256 neoadjuvant). Monotonicity and strength of survival trends, by stage, were assessed (log-rank test of trend chi-square statistic) and compared using permutation testing. Overall survival (Cox regression) and model fit (Akaike Information Criterion) were determined.

absSec_3">Results

abspara0020">A greater log-rank test of trend statistic indicated stronger survival trends by stage in AJCC 7th (152.872 vs 167.623; permutation test P < .001) edition. Greater Cox likelihood chi-square value (162.957 vs 173.951) and lower Akaike Information Criterion (4,831.011 vs 4,820.016) indicated better model fit. Superior performance was also shown after neoadjuvant therapy.

absSec_4">Conclusion

abspara0025">AJCC 7th edition staging for esophagogastric adenocarcinoma provides superior prognostic stratification after minimally invasive esophagectomy, overall and after neoadjuvant therapy compared with AJCC 6th edition.