AJCC第7版与第8版分期对乳腺癌患者预后预测的比较分析
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摘要
背景与目的:美国癌症联合委员会(American Joint Committee on Cancer,AJCC)第8版乳腺癌分期在传统解剖因素基础上,结合生物标志物,建立了一种全新的乳腺癌预后分期系统。该研究旨在分析AJCC第8版乳腺癌分期的临床应用价值。方法:分析222例乳腺癌根治术后出现复发转移的患者,按照AJCC第7版解剖分期:肿瘤(tumor,T)分期、淋巴结(node,N)分期、转移(metastasis,M)分期,和第8版预后分期标准进行初诊状态再分期,比较不同标准分期的差异及与预后的关系,生存分析采用Kaplan-Meier方法,log-rank法检验无病生存期(disease-free survival,DFS)的差异。结果:按照AJCC第7版分期标准,ⅠA、ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期的患者分别为34例(15.3%)、0例(0.0%)、73例(32.9%)、26例(11.7%)、45例(20.3%)、4例(1.8%)和40例(18.0%);按照AJCC第8版预后分期标准,ⅠA、ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期的患者分别为47例(21.2%)、35例(15.8%)、55例(24.8%)、17例(7.7%)、25例(11.3%)、30例(13.5%)和13例(5.9%),差异有统计学意义(P=0.000)。分期变化主要有:第7版Ⅰ期细分为第8版ⅠA和ⅠB期;第7版ⅡA期细分为第8版ⅠA、ⅠB和ⅡA期;第7版ⅡB期细分为第8版ⅠA、ⅠB、ⅡA、ⅡB和ⅢA期;第7版ⅢA期细分为第8版ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期;第7版ⅢB和ⅢC期细分为第8版ⅢA、ⅢB和Ⅲc期。AJCC第7版TNM分期和第8版预后分期与患者DFS比较差异均有统计学意义(P=0.002和0.001),第8版预后分期ⅢB和ⅢC期亚组的DFS更为准确。结论:AJCC第8版预后分期能够准确预测乳腺癌患者的预后。
Background and purpose: The American Joint Committee on Cancer (AJCC) 8~(th) edition cancer staging manual introduced a new prognostic staging system for breast cancer incorporating biological markers in addition to traditional anatomical factors. The purpose of this study was to determine the clinical value of the 8~(th) edition AJCC classification for breast cancer. Methods: The data from 222 recurrent or metastatic cases of breast cancer after operation were analyzed. Cancer staging was determined using the 7~(th) edition anatomical staging criteria including tumor (T), node (N) and metastasis (M), and was further evaluated using 8~(th) edition prognostic classification. We compared the two staging systems and their relations to prognosis. KaplanMeier and log-rank tests were used for univariate comparison of disease-free survival (DFS). Results: The percentages of ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 34 (15.3%), 0 (0.0%), 73 (32.9%), 26 (11.7%), 45 (20.3%), 4 (1.8%) and 40 (18.0%) according to AJCC 7~(th) edition anatomical TNM staging system, respectively. The percentages of ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 47 (21.2%), 35 (15.8%), 55 (24.8%), 17 (7.7%), 25 (11.3%), 30 (13.5%) and 13 (5.9%) according to AJCC 8th edition prognostic staging system, respectively. The difference between the two staging groups was significant (P=0.000). Changes occurred mainly in the following categories: the 7~(th) edition ⅠA was divided into the 8~(th) edition ⅠA and ⅠB categories; ⅡA was divided into ⅠA, ⅠB and ⅡA; ⅡB was divided into ⅠA, ⅠB, ⅡA, ⅡB and ⅢA; ⅢA was divided into ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC; and both the 7~(th) edition ⅢB and ⅢC were divided into the 8th edition ⅢA, ⅢB and ⅢC categories. There was statistically significant difference in DFS between stage groups according to both AJCC 7~(th) edition TNM and 8~(th) edition prognostic staging systems (P=0.002 and 0.001), and the DFS in ⅢB and ⅢC groups according to AJCC 8~(th) edition prognostic staging system was more accurate compared with AJCC 7~(th) edition. Conclusion: The 8~(th) edition AJCC prognostic classification could exactly predict the prognosis of breast cancer.
Background and purpose: The American Joint Committee on Cancer (AJCC) 8~(th) edition cancer staging manual introduced a new prognostic staging system for breast cancer incorporating biological markers in addition to traditional anatomical factors. The purpose of this study was to determine the clinical value of the 8~(th) edition AJCC classification for breast cancer. Methods: The data from 222 recurrent or metastatic cases of breast cancer after operation were analyzed. Cancer staging was determined using the 7~(th) edition anatomical staging criteria including tumor (T), node (N) and metastasis (M), and was further evaluated using 8~(th) edition prognostic classification. We compared the two staging systems and their relations to prognosis. KaplanMeier and log-rank tests were used for univariate comparison of disease-free survival (DFS). Results: The percentages of ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 34 (15.3%), 0 (0.0%), 73 (32.9%), 26 (11.7%), 45 (20.3%), 4 (1.8%) and 40 (18.0%) according to AJCC 7~(th) edition anatomical TNM staging system, respectively. The percentages of ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 47 (21.2%), 35 (15.8%), 55 (24.8%), 17 (7.7%), 25 (11.3%), 30 (13.5%) and 13 (5.9%) according to AJCC 8th edition prognostic staging system, respectively. The difference between the two staging groups was significant (P=0.000). Changes occurred mainly in the following categories: the 7~(th) edition ⅠA was divided into the 8~(th) edition ⅠA and ⅠB categories; ⅡA was divided into ⅠA, ⅠB and ⅡA; ⅡB was divided into ⅠA, ⅠB, ⅡA, ⅡB and ⅢA; ⅢA was divided into ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC; and both the 7~(th) edition ⅢB and ⅢC were divided into the 8th edition ⅢA, ⅢB and ⅢC categories. There was statistically significant difference in DFS between stage groups according to both AJCC 7~(th) edition TNM and 8~(th) edition prognostic staging systems (P=0.002 and 0.001), and the DFS in ⅢB and ⅢC groups according to AJCC 8~(th) edition prognostic staging system was more accurate compared with AJCC 7~(th) edition. Conclusion: The 8~(th) edition AJCC prognostic classification could exactly predict the prognosis of breast cancer.
引文
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[8]XU L,LI JH,YE JM,et al.A retrospective survival analysis of anatomic and prognostic stage group based on the American Joint Committee on Cancer 8th edition cancer staging manual in luminal B human epidermal growth factor receptor 2-negative breast cancer[J].Chin Med J(Engl),2017,130(16):1945-1952.
[2]GIULIANO A E,EDGE S B,HORTOBAGYI G N.Eighth edition of the AJCC cancer staging manual:breast cancer[J].Ann Surg Oncol,2018,25(7):1783-1785.
[3]GIULIANO A E,CONNOLLY J L,EDGE S B,et al.Breast cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J].CA Cancer JClin,2017,67(4):290-303.
[4]WANG M,CHEN H,WU K,et al.Evaluation of the prognostic stage in the 8th edition of the American Joint Committee on Cancer in locally advanced breast cancer:an analysis based on SEER 18 database[J].Breast,2018,37(2):56-63.
[5]WEISS A,CHAVEZ-MACGREGOR M,LICHTENSZTAJND Y,et al.Validation study of the American Joint Committee on Cancer eighth edition prognostic stage compared with the anatomic stage in breast cancer[J].JAMA Oncol,2018,4(2):203-209.
[6]HU H,WEI W,YI X,et al.A retrospective analysis of clinical utility of AJCC 8th edition cancer staging system for breast cancer[J].World J Oncol,2017,8(3):71-75.
[7]ZHOU B,XU L,YE J,et al.The prognostic value of the 8th edition of the American Joint Committee on Cancer(AJCC)staging system in HER-2-enriched subtype breast cancer,a retrospective analysis[J].Anticancer Res,2017,37(8):4615-4621.
[8]XU L,LI JH,YE JM,et al.A retrospective survival analysis of anatomic and prognostic stage group based on the American Joint Committee on Cancer 8th edition cancer staging manual in luminal B human epidermal growth factor receptor 2-negative breast cancer[J].Chin Med J(Engl),2017,130(16):1945-1952.