第7版与第8版美国癌症联合会肝癌TNM分期对术后无瘤生存的预测比较

A comparison the 7th and 8th edition AJCCTNM staging systems for predicting disease free survival time after surgery in primary liver cancer patients

目的比较第7版与第8版美国癌症联合会（American Joint Committee on Cancer，AJCC）TNM分期对肝癌患者术后无瘤生存的预测价值。方法回顾性分析2013年6月至2017年2月接受手术治疗且随访资料完整的200例肝癌患者的资料，采用Kaplan-Meier曲线分析患者的无瘤生存情况，秩相关法及受试者工作特征（receiver operating characteristic，ROC）曲线比较两版分期的效果。结果共纳入200例患者。根据第7版分期，Ⅰ期患者114例、Ⅱ期患者64例、Ⅲ期患者18例及Ⅳ期患者4例。根据第8版分期，ⅠA期患者33例、ⅠB期患者85例、Ⅱ期患者60例、Ⅲ期患者18例及Ⅳ期患者4例。两版分期对患者的术后无瘤生存均表现出良好的判断能力（χ2＝31.177、40.073，P〈0.01），同时第8版分期的ROC曲线优于第7版。第8版ⅠA期患者的无瘤生存优于第7版Ⅰ期以及第8版ⅠB期患者（χ2＝5.701，P＝0.017；χ2＝7.865，P＝0.005）。第7版Ⅰ期与第8版ⅠB期比较差异无统计学意义（χ2＝0.753，P＝0.385）。 结论AJCC第8版肝癌TNM分期对患者术后无瘤生存的评估价值优于第7版分期，且对Ⅰ期患者的评估更为精准。

ObjectiveTo explore the value of the 7th and 8th edition AJCC TNM staging systems for hepatocellular cancer about disease free survival （DFS） after surgery.MethodsClinical data of hepatocellular cancinoma patients were analyzed retrospectively. The difference of the two staging systems in predicting DFS were compared by Kaplan-Meier analytical method and ROC test.ResultsBased on AJCC 7th edition, there were 114 phase Ⅰ patients, 64 phase Ⅱpatients, 18 phase Ⅲ patients, 4 phase Ⅳ patients, while based on 8th edition, there were 33 phase IA patients, 85 ⅠB patients, 60 phase Ⅱpatients, 18 phase Ⅲ patients and 4 phase Ⅳ patients. There was a significant difference in the survival curve between the two stages （χ2=31.177, 40.073, P〈0.01）. At the same time, the area under the ROC curve in the 8th edition was better than that in the 7th edition. In addition, in the 8th edition the DFS curve of phase ⅠA was superior to that of phase Ⅰ in 7th edition, and to that of phase ⅠB in the 8th edition （χ2=5.701, P=0.017; χ2=7.865, P=0.005）. There was no significant difference between that of phase Ⅰ in the 7th edition and that of phase ⅠB in the 8th edition （χ2=0.753, P=0.385）.ConclusionThe value of the 8th AJCC TNM staging in evaluating postoperative DFS is better than the 7th stage, especially for stage Ⅰ patients.