食管癌UICC/AJCC第8版临床分期对根治性放疗患者预后评估价值
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摘要
目的 2018年食管癌UICC/AJCC第8版分期被提出,包括临床分期、病理分期和新辅助病理分期,填补了食管癌非手术分期的空白。本研究验证食管癌UICC/AJCC第8版临床分期对根治性放疗患者预后的评估价值。方法选取2010-03-01-2016-09-30在天津市肿瘤医院接受根治性放疗的544例食管癌患者,按照第8版临床分期标准进行分期分析,采用Kaplan-Meier法进行生存分析,Cox多因素模型分析预后。结果按照食管癌第8版临床分期,T_2期40例,T_3期157例,T_4期347例;N_0期132例,N_1期193例,N_2期172例,N_3期47例;Ⅱ期81例,Ⅲ期102例,ⅣA期361例。T_2～T_4期患者的3年生存率分别为60.1%、45.6%和30.8%,差异有统计学意义,P<0.001。N_0～N_3期患者的3年生存率分别为48.2%、40.7%、29.4%和17.3%,差异有统计学意义,P<0.001。Ⅱ～ⅣA期患者的3年生存率分别为59.3%、40.1%和31.2%,差异有统计学意义,P<0.001。单因素分析显示,年龄、是否同步放化疗、T分期、N分期、UICC/AJCC第6版分期、UICC/AJCC第8版分期、KPS评分是影响预后的重要因素,均P<0.05。多因素分析显示,是否同步放化疗和N分期是影响预后的独立危险因素,均P<0.05。结论基于天津市肿瘤医院数据,第8版食管癌临床分期能较好的预测根治性放疗的非手术食管癌患者预后。
OBJECTIVE In early 2018,UICC/AJCC 8th edition staging system of esophageal cancer was proposed.The 8th edition staging system included clinical staging,pathological staging and neoadjuvant pathological staging,which filled in the blank of non-operative staging of esophageal cancer.This study aimed to verify the prognostic value of the new American Joint Committee on Cancer(AJCC)clinical staging system for esophageal cancer patients who undergo radical radiation therapy.METHODS A total of 544 patients with esophageal cancer from Tianjin Medical University Cancer Institute and Hospital between March 2010 and September 2016 were staged according to the 8th AJCC clinical staging system.The Kaplan-Meier method was used to calculate the survival rate of the patients.The Cox regression model was used for multivariate prognostic analysis.RESULTS All the patients were divided into different groups by 8th AJCC clinical TNM staging system,40 cases in T_2,157 cases in T_3,347 cases in T_4,132 cases in N_0,193 cases in N_1,172 cases in N_2,47 cases in N_3,stage Ⅱ:81 cases;stage Ⅲ:102 cases;stage ⅣA:361 cases.The 3-year survival rate of stage T_2,T_3 and T_4 were 60.1%,45.6% and 30.8%,respectively(P<0.001).The 3-year survival rate of stage N_0,N_1,N_2 and N_3 were48.2%,40.7%,29.4% and 17.3%,respectively(P<0.001).The 3-year survival rate of stageⅡ,Ⅲ and ⅣA were 59.3%,40.1% and 31.2%(P<0.001).In univariate analysis,age,concurrent chemoradiotherapy,T stage,N stage,KPS marking system,UICC/AJCC 6th edition staging system and UICC/AJCC 8th edition staging system were the important prognostic factors.In multivariate analysis,concurrent chemoradiation therapy and N stage were independent risk factors.CONCLUSION Based on the data from Tianjin Medical University Cancer Institute and Hospital,the 8th edition clinical staging system has a better predict ability for esophageal cancer patients who underwent radical radiation therapy.
OBJECTIVE In early 2018,UICC/AJCC 8th edition staging system of esophageal cancer was proposed.The 8th edition staging system included clinical staging,pathological staging and neoadjuvant pathological staging,which filled in the blank of non-operative staging of esophageal cancer.This study aimed to verify the prognostic value of the new American Joint Committee on Cancer(AJCC)clinical staging system for esophageal cancer patients who undergo radical radiation therapy.METHODS A total of 544 patients with esophageal cancer from Tianjin Medical University Cancer Institute and Hospital between March 2010 and September 2016 were staged according to the 8th AJCC clinical staging system.The Kaplan-Meier method was used to calculate the survival rate of the patients.The Cox regression model was used for multivariate prognostic analysis.RESULTS All the patients were divided into different groups by 8th AJCC clinical TNM staging system,40 cases in T_2,157 cases in T_3,347 cases in T_4,132 cases in N_0,193 cases in N_1,172 cases in N_2,47 cases in N_3,stage Ⅱ:81 cases;stage Ⅲ:102 cases;stage ⅣA:361 cases.The 3-year survival rate of stage T_2,T_3 and T_4 were 60.1%,45.6% and 30.8%,respectively(P<0.001).The 3-year survival rate of stage N_0,N_1,N_2 and N_3 were48.2%,40.7%,29.4% and 17.3%,respectively(P<0.001).The 3-year survival rate of stageⅡ,Ⅲ and ⅣA were 59.3%,40.1% and 31.2%(P<0.001).In univariate analysis,age,concurrent chemoradiotherapy,T stage,N stage,KPS marking system,UICC/AJCC 6th edition staging system and UICC/AJCC 8th edition staging system were the important prognostic factors.In multivariate analysis,concurrent chemoradiation therapy and N stage were independent risk factors.CONCLUSION Based on the data from Tianjin Medical University Cancer Institute and Hospital,the 8th edition clinical staging system has a better predict ability for esophageal cancer patients who underwent radical radiation therapy.
引文
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[22]许宗渠,刘锦源,周悦,骆金华等.超声内镜对食管癌术前TN分期诊断的准确性及其影响因素[J].中国临床研究,2018,31(4):455-458.
[23]Pisani P,Parkin DM,Bray F,et al.Erratum:Estimates of the worldwide mortality from 25cancers in 1990[J].Int J Cancer,1999,83(6):870-873.
[24]Parkin DM,Pisani P,Ferlay J.Estimates of the worldwide incidence of eighteen major cancers in 1985[J].Int J Cancer,1993,54(4):594-606.
[25]Schmoll HJ.GreeneFL,D.L.PageDL,et al.AJCC Cancer Staging Manual,6th edition[J].Ann Oncol,2003,14(2):345-a-346(342).
[26]Cuccurullo V,Mansi L.AJCC Cancer Staging Handbook:from the AJCC Cancer Staging Manual(7th edition)[J].Eur J Nucl Med Mol Imaging,2011,38(2):408-408.
[27]Zahoor H,Luketich JD,Weksler B,et al.The revised American Joint Committee on Cancer staging system(7th edition)improves prognostic stratification after minimally invasive esophagectomy for esophagogastric adenocarcinoma[J].Am J Surg,2015,210(4):610-617.
[28]Coral RV,Bigolin AV,Coral RP,et al.Metastatic lymph node ratio,6th or 7th AJCC edition:witch is the bestlymph node classification for esophageal cancer?Prognosis factor analysis in487patients[J].Arq Bras Dir Dig,2015,28(2):94-97.
[29]Puli SR,Reddy JB,Bechtold ML,et al.Staging accuracy of esophageal cancer by endoscopic ultrasound:A meta-analysis and systematic review[J].World J Gastroenterol,2008,14(10):1479-1490.
[30]Pech O,Günter E,Dusemund F,et al.Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer:results from a referral center for early esophageal cancer[J].Endoscopy,2010,42(6):456-461.
[31]Choi JY,Lee KH,Shim YM,et al.Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET[J].J Nucl Med,2000,41(5):808-815.
[32]Kim TJ,Kim HY,Lee KW,et al.Multimodality assessment of esophageal cancer:preoperative staging and monitoring of response to therapy[J].Radiographics,2009,29(2):403-421.
[33]Doescher J,Veit JA,Hoffmann TK.The 8th edition of the AJCCCancer Staging Manual[J].HNO,2017,65(12):956-961.
[34]Cooper JS,Guo MD,Herskovic A,et al.Chemoradiotherapy of locally advanced esophageal cancer:long-term follow-up of a prospective randomized trial(RTOG 85-01)[J].JAMA,1999,281(17):1623-1627.
[35]Xing L,Liang Y,Zhang J,et al.Definitive chemoradiotherapy with capecitabine and cisplatin for elder patients with locally advanced squamous cell esophageal cancer[J].J Cancer Res Clinl Oncol,2014,140(5):867-872.
[36]Chen F,Luo H,Xing L,et al.Feasibility and efficiency of concurrent chemoradiotherapy with capecitabine and cisplatin versus radiotherapy alone for elderly patients with locally advanced esophageal squamous cell carcinoma:Experience of two centers[J].Thorac Cancer,2018,9(1):59-65.
[2]Ferlay J,Soerjomataram I,Dikshit R,et al.Cancer incidence and mortality worldwide:sources,methods and major patterns in GLOBOCAN 2012[J].Int J Cancer,2015,136(5):E359-E386.
[3]Short MW,Burgers KG,Fry VT.Esophageal Cancer[J].Am Fam Physician,2017,95(1):22-28.
[4]Rice TW,Ishwaran H,Blackstone EH,et al.Recommendations for clinical staging(cTNM)of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals[J].Dis Esophagus,2016,29(8):913-919.
[5]Rice TW,Gress DM,Patil DT,et al.Cancer of the esophagus and esophagogastric junction—Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J].CA Cancer J Clin,2017,67(4):304-317.
[6]Donohoe CL,Phillips AW.Cancer of the esophagus and esophagogastric junction:an 8th edition staging primer[J].J Thorac Dis,2017,12(1):36-42.
[7]Zhang D,Zheng Y,Wang Z,et al.Comparison of the 7th and proposed 8th editions of the AJCC/UICC TNM staging system for esophageal squamous cell carcinoma underwent radical surgery[J].Eur J Surg Oncol,2017,43(10):1949-1955.
[8]Zanoni A,Verlato G,Baiocchi GL,etal.Siewert III esophagogastric junction adenocarcinoma:does TNM 8th save us?[J].Updates Surg,2018,70(2):1-9.
[9]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,2017,130(16):1945-1952.
[10]郑洪庆,张珂诚,卫勃,等.胃癌TNM分期第八版更新在临床诊断治疗中的意义和思考[J].中华胃肠外科杂志,2017,20(2):166-170.
[11]Van OH,Laméris JS,Berger MY,et al.Supraclavicular lymph node metastases in carcinoma of the esophagus and gastroesophageal junction:assessment with CT,US,and US-guided fine-needle aspiration biopsy[J].Radiol,1991,179(1):155-158.
[12]Ampil FL,Caldito G,Li BD,et al.Computed tomographic staging of esophageal cancer and prognosis[J].Radiat Med,2001,19(3):127-129.
[13]Thibouw D,Truc G,Bertaut A,et al.Clinical and dosimetric study of radiotherapy for glioblastoma:three-dimensional conformal radiotherapy versus intensity-modulated radiotherapy[J].J Neurooncol,2018,137(2):1-10.
[14]Rice TW,Blackstone EH.Esophageal cancer staging:past,present,and future[J].Thorac Surg Clin,2013,23(4):461-469.
[15]Fang P,Shiraishi Y,Verma V,et al.Lymphocyte-sparing effect of proton therapy in patients with esophageal cancer treated with definitive chemoradiation[J].Int J Part Ther,2018,4(3):23-32.
[16]Shapiro J,van Lanschot JJB,Hulshof M,et al.Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer(CROSS):long-term results of a randomised controlled trial[J].Lancet Oncol,2015,16(9):1090-1098.
[17]Hsu PK,Wu YC,Chou TY,et al.Comparison of the 6th and 7th editions of the American Joint Committee on Cancer tumor-nodemetastasis staging system in patients with resected esophageal carcinoma[J].Ann Thorac Surg,2010,89(4):1024-1031.
[18]Gaur P,Hofstetter WL,Bekele BN,et al.Comparison between established and the Worldwide Esophageal Cancer Collaboration staging systems[J].Ann Thorac Surg,2010,89(6):1797-1803,1804.
[19]Rice T,Rusch VH,C,Allen M,et al.Worldwide esophageal cancer collaboration[J].Dis Esophagus,2010,22(1):1-8.
[20]TW R,EH B,LA R,et al.Refining esophageal cancer staging[J].J Thorac Cardiovasc Surg,2003,125(5):1103-1113.
[21]Rice TW,Gress DM,Patil DT,et al.Cancer of the esophagus and esophagogastric junction-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J].CA Cancer J Clin,2017,67(4):304-317.
[22]许宗渠,刘锦源,周悦,骆金华等.超声内镜对食管癌术前TN分期诊断的准确性及其影响因素[J].中国临床研究,2018,31(4):455-458.
[23]Pisani P,Parkin DM,Bray F,et al.Erratum:Estimates of the worldwide mortality from 25cancers in 1990[J].Int J Cancer,1999,83(6):870-873.
[24]Parkin DM,Pisani P,Ferlay J.Estimates of the worldwide incidence of eighteen major cancers in 1985[J].Int J Cancer,1993,54(4):594-606.
[25]Schmoll HJ.GreeneFL,D.L.PageDL,et al.AJCC Cancer Staging Manual,6th edition[J].Ann Oncol,2003,14(2):345-a-346(342).
[26]Cuccurullo V,Mansi L.AJCC Cancer Staging Handbook:from the AJCC Cancer Staging Manual(7th edition)[J].Eur J Nucl Med Mol Imaging,2011,38(2):408-408.
[27]Zahoor H,Luketich JD,Weksler B,et al.The revised American Joint Committee on Cancer staging system(7th edition)improves prognostic stratification after minimally invasive esophagectomy for esophagogastric adenocarcinoma[J].Am J Surg,2015,210(4):610-617.
[28]Coral RV,Bigolin AV,Coral RP,et al.Metastatic lymph node ratio,6th or 7th AJCC edition:witch is the bestlymph node classification for esophageal cancer?Prognosis factor analysis in487patients[J].Arq Bras Dir Dig,2015,28(2):94-97.
[29]Puli SR,Reddy JB,Bechtold ML,et al.Staging accuracy of esophageal cancer by endoscopic ultrasound:A meta-analysis and systematic review[J].World J Gastroenterol,2008,14(10):1479-1490.
[30]Pech O,Günter E,Dusemund F,et al.Accuracy of endoscopic ultrasound in preoperative staging of esophageal cancer:results from a referral center for early esophageal cancer[J].Endoscopy,2010,42(6):456-461.
[31]Choi JY,Lee KH,Shim YM,et al.Improved detection of individual nodal involvement in squamous cell carcinoma of the esophagus by FDG PET[J].J Nucl Med,2000,41(5):808-815.
[32]Kim TJ,Kim HY,Lee KW,et al.Multimodality assessment of esophageal cancer:preoperative staging and monitoring of response to therapy[J].Radiographics,2009,29(2):403-421.
[33]Doescher J,Veit JA,Hoffmann TK.The 8th edition of the AJCCCancer Staging Manual[J].HNO,2017,65(12):956-961.
[34]Cooper JS,Guo MD,Herskovic A,et al.Chemoradiotherapy of locally advanced esophageal cancer:long-term follow-up of a prospective randomized trial(RTOG 85-01)[J].JAMA,1999,281(17):1623-1627.
[35]Xing L,Liang Y,Zhang J,et al.Definitive chemoradiotherapy with capecitabine and cisplatin for elder patients with locally advanced squamous cell esophageal cancer[J].J Cancer Res Clinl Oncol,2014,140(5):867-872.
[36]Chen F,Luo H,Xing L,et al.Feasibility and efficiency of concurrent chemoradiotherapy with capecitabine and cisplatin versus radiotherapy alone for elderly patients with locally advanced esophageal squamous cell carcinoma:Experience of two centers[J].Thorac Cancer,2018,9(1):59-65.