AJCC第八版食管癌分期系统中N分期策略的探讨

Discussion of N staging category of the eighth edition of The AJCC Esophageal Cancer Staging System

AJCC第8版食管癌分期系统将于2018年1月1日开始实施.第8版食管癌分期系统中N分期延续第7版的分期标准,仍基于转移淋巴结数目进行,对区域淋巴结的范围进行了局部修订.回顾N分期的修订过程,从粗略地分为是否存在转移,到第7版根据转移数目分为N0～N3期,细化的N分期对食管癌进展程度的判定和预后的分析均有较为理想的表现.然而,目前的N分期方案仍有不足.国内外研究结果显示,淋巴结转移区域可更为精确地进行分期和反映预后,本文提出了具体的淋巴结转移区域分期策略.本文还讨论了食管胃交界癌N分期的争议,以及淋巴结转移率、淋巴管侵犯、相关分子标志物等指标在食管癌预后和N分期中的指导价值和不足,并对食管癌分期系统中N分期策略未来的发展进行了展望.

AJCC Esophageal Cancer Staging System, 8th edition will be implemented on January 1, 2018. The N staging in 8th edition of staging system remains following 7th edition based on the number of metastatic nodes, except the limited revision of the regional lymph node map. N staging revision was reviewed from the simple definition of negative （ N0） and positive （ N1） lymph node（ s） to the positive node number based proposal （7th edition）. The 7th edition staging system, especially the N staging, were proved with more advantages on distinguishing disease progression and predicting prognosis of the esophageal cancer. On other hand, the disadvantages of 7th edition N staging are discussed. The refined N staging based on the number of metastatic node station is introduced. The extent and station of metastatic node could better reflect the disease progression and prognosis according to our research. The controversy on N staging of esophagogastric junction cancer is discussed as well. Other reported N staging associated index including lymph node ratio, lymphatic vessel invasion and biomarkers are reviewed and evaluated.