第6版和第7版UICC-AJCCTNM分期系统预测食管癌根治性切除术后生存情况的比较:基于400例食管癌患者的临床分析

Comparison of the predictive value of the 6th and the 7th editions of the UICC-AJCC TNM staging systems in prognosis of esophageal cancer after radical resection: Analysis of 400 patients with esophageal cancer

目的:本研究旨在比较第6版和第7版国际抗癌联盟-美国癌症联合委员会(Union for International Cancer Control-American Joint Committeeon Cancer,UICC-AJCC)TNM分期系统在判断食管癌患者预后中的价值。方法:研究对象为2006年8月—2009年9月在本院接受食管癌根治性切除术的400例食管癌患者,并按照第6版和第7版UICC-AJCC食管癌TNM分期系统分别进行TNM分期和临床分期。应用单因素分析(Kaplan-Meier法)和多因素分析(COX比例风险模型)探讨食管癌患者的预后相关因素。结果:无论是按照第6版还是第7版UICC-AJCC食管癌TNM分期系统,Ⅰ、Ⅱ以及Ⅲ+Ⅳ期患者的3年总生存率差异均有统计学意义(P<0.000)。按照第7版UICC-AJCC食管癌TNM分期系统,ⅢA、ⅢB和ⅢC期患者的3年总生存率差异有统计学意义(P=0.001);N0、N1、N2和N3患者的3年总生存率分别为71.8%、54.4%、31.6%和25.0%,差异有统计学意义(P<0.000)。COX比例风险模型多因素分析结果显示,无论是按照第6版还是第7版,肿瘤大小、分化程度、浸润深度(T分期)和区域淋巴结转移(N分期)因素均是食管癌根治性切除术后的独立预后因素(P<0.05)。结论:第6版还是第7版UICC-AJCC食管癌TNM分期系统均能较好地预测食管癌根治性切除术后患者的预后,肿瘤大小、分化程度、浸润深度(T分期)和区域淋巴结转移(N分期)因素都是重要的独立预后因素。鉴于第7版UICC-AJCC食管癌TNM分期系统更加细致,因此它能够更加准确地预测预后,对食管癌患者的临床治疗具有更佳的指导意义。

Objective： To compare the predictive value of the 6th and the 7th editions of the UICC- AJCC （Union for International Cancer Control-American Joint Committee on Cancer） TNM staging systems in prognosis of esophageal cancer after radical resection. Methods： Four hundred patients receiving radical resection of esophageal cancer between August 2006 and September 2009 were collected. The TNM staging and clinical staging were identified according to the 6th and the 7th editions of the UICC- AJCC TNM staging systems. The prognosis-related factors were evaluated using univariate analysis （Kaplan-Meier method） and multivariate analysis （COX proportional hazards model）. Results： The three- year overall survival rates among patients with stagesⅠ, Ⅱ, and Ⅲ-Ⅳ were both significantly different （P 〈 0.000） according to the 6th and the 7th editions of the UICC-AJCC TNM staging systems. Based on the 7th edition, the three-year overall survival rates among patients with stages IliA, IIIB, and IIIC were significantly different （P = 0.001）; the three-year overall survival rates of the patients with stages N0, N1, N2 and N3 were 71.8%, 54.4%, 31.6% and 25.0%, respectively, and there existed significant difference in overall survival rate （P 〈 0.000）. The COX proportional hazards model analysis revealed that according to the 6th and the 7th editions of the UICC-AJCC TNM staging systems, the factors of tumor size,differentiation, invasion depth （T staging）, and lymph node metastases （N staging） were independent prognostic factors （all P 〈 0.05） for patients receiving radical resection of esophageal cancer. Conclusion： Both the 6th and the 7th editions of the UICC-AJCC TNM staging systems can be able to reflect the clinical prognosis of patients receiving radical resection of esophageal cancer, and the factors of tumor size, differentiation, invasion depth （T staging） and lymph node metastases （N staging） are the independent predictors of prognosis. Given the 7th edition of the UICC-AJCC TNM staging system for esophageal cancer is more precise than the 6th edition, it can be more effective in the prognostic prediction and the guidance of clinical treatment for patients with esophageal cancer.