胃癌AJCC分期第6版与第7版的差异及其对预后评估的分析与比较

The analysis of gastric cancer staging AJCC 6th ed.and 7th ed.

目的比较胃癌美国癌症联合会(AJCC)分期第6版与第7版的差异,分析、评价新的胃癌TNM分期方法的临床应用价值。方法回顾性分析1995年9月至2007年12月在北京大学临床肿瘤学院接受治疗并具有完整临床病理资料的922例胃癌病人,比较其根据AJCC新旧两版标准分期后的预后情况。结果胃癌第7版AJCC分期在T、N分期方面均进行了比较明显的调整,与第6版相比分期标准更为精细化,第7版分期标准对N分期进行的调整可以更好地对不同预后的病人进行区分,COX模型分析表明M分期、新版N分期、旧版TNM分期以及淋巴结清扫是否充分是反映胃癌预后最主要的独立因素。结论与第6版分期相比,第7版的T分期、N分期标准更为合理,但新版的TNM综合分期标准对于预后评估却并未体现出优势,其具体临床价值仍有待探索。

Objective To evaluate clinical value of the 7thed gastric cancer staging AJCC by comparing with the 6thed. Methods It performed a retrospective analysis of 922 gastric cancer patients with complete clinical data. The patients had all been treated in Beijing Cancer Hospital from Sep. 1995 to Dec. 2007. The prognostic differences between the 6th ed. gastric cancer staging AJCC and the 7th ed. were analyzed by the Kaplan-Meier method and compared by the log-rank test. The multivariate analysis used the Cox stepwisc logistic regression. Results The 7th ed. witnessed considerable adjustments in T staging and N staging which showed better performance in prognosis of gastric cancer patients. In a multivariate Cox model, patients who had earlier M staging, earlier 7th ed. N staging, earlier 6th ed. TNM staging and lymph node dissection were associated with better survival. Conclusion T staging and N staging of 7th ed. show better performance, but the 7th TNM staging has not been proven to be superior to the 6th ed., and the further study should be carried out to verification.