食管癌新旧分期系统预后价值的比较

Comparison of the Prognostic Values between the Sixth and Seventh Editions of the AJCC Staging System in Postoperative Esophageal Cancer Patients

目的：比较第7版和第6版AJCC食管癌分期系统对可切除的食管鳞癌患者的预后评估的差异.方法：选取天津医科大学附属肿瘤医院1999年1月至2004年12月间398例食管鳞状细胞癌术后有完整资料患者的临床病理和5年随访资料,通过Kaplan-Meier生存曲线法描述生存过程,Log-Rank检验不同分期的生存率的差异,x2检验比较组间差异.结果：按照AJCC第6版及第7版两种不同的TNM分期方法对398例患者的临床病理结果进行分期,总的5年生存率为26.9%.新分期后,由于转移淋巴结数目和肿瘤分化程度的标准不同,Ⅰ期及Ⅳ期的例数均有所增加,各期别生存差异较第6版更加显著.其5年生存率分别为62.5%,33.9%,15%,3.4%.结论：AJCC食管癌第7版分期能够更好的反映食管癌术后患者的预后,转移淋巴结数目的对预后的影响更显重要.

Objective： To evaluate the prognostic significance of the 7th edition AJCC TNM staging system and to com- pare the difference between the 6th and 7th editions of the AJCC staging system in postoperative esophageal squamous cancer （ESCa） patients. Methods： Clinicopathologic and 5-year follow-up data of 398 ESCa patients, who received primary surgical resection during a period between January 1999 and December 2004, were included. Survival analysis was con- ducted using the Kaplan-Meier curve. Log-Rank test was conducted to assess the difference between the two staging sys- tems. The ~2 test was used for comparing the difference between the groups. Results： The clinicopathologic results of these patients were staged based on the TNM staging of the two editions. The average five-year survival rate for the entire cohort was 26.9%. Using the new staging system, the number of phase I and phase IV cases is increased because of the defini- tion in the number of metastasized lymph nodes and degree of tumor differentiation. The differences in survival in the stag- es become more distinct. In the 7th edition, the 5-year survival rate is 62.5%, 33.9%, 15%, and 3.4%, for stages Ⅰ, Ⅱ, Ⅲ and Ⅳ, respectively, showing significant differences among the survival rates of cases at various stages. Conclusions： The 7th edition AJCC TNM staging system is better able to stage the prognosis of ESCa patients compared to its previous edi- tion. Using this edition, the number of metastasized lymph nodes can be clearly estimated and this is significant for determining the correct prognosis.