第七版与第八版美国癌症联合会TNM分期对口咽癌预后生存的分析比较

A comparison of the 7th and 8th edition of the AJCC TNM staging systems for predicting survival in oropharyngeal cancer

目的:比较第七版与第八版美国癌症联合会(AJCC)TNM分期对口咽癌生存的预测情况。方法:回顾性分析142例口咽鳞状细胞癌患者的临床病理资料。p16蛋白检测采用免疫组织化学染色法。生存率及生存分析采用Kaplan-Meier法和Log-rank检验。结果:142例口咽鳞状细胞癌患者5年疾病特异生存率(DSS)为55.4%,总生存率为50.4%,中位生存时间60.3个月。口咽鳞状细胞癌患者p16蛋白阳性表达率为27.5%(39/142)。依据第七版AJCC分期,Ⅰ期患者4例,Ⅱ期17例,Ⅲ期27例,Ⅳ期94例;Ⅰ~Ⅱ期患者5年DSS为75.9%,Ⅲ~Ⅳ期患者为52.2%,但二者差异无统计学意义(P=0.109)。而在第八版AJCC分期中,Ⅰ期患者22例,Ⅱ期24例,Ⅲ期27例,Ⅳ期69例;各临床分期5年DSS分别为:Ⅰ期88.4%,Ⅱ期80.5%,Ⅲ期73.2%,Ⅳ期29.1%,总体上比较差异有统计学意义(P=0.000)。结论:与第七版分期相比,第八版AJCC口咽癌分期系统考虑了不同病因口咽癌患者的预后情况,能够更加准确地预测患者的预后。

Objective:The aim of this study is to evaluate the prognostic value of the 8 th edition of AJCC TNM classification in comparison with the 7 th edition for oropharyngeal cancer.Method:The clinical and pathological data of 142 patients with oropharyngeal squamous cell carcinoma were retrospectively analyzed.The p16 protein was detected by immunohistochemical staining.Survival and survival analysis were performed using the Kaplan-Meier method and the Log-rank test.Result:The 5-year disease-specific survival(DSS),the 5-year overall survival(OS)and the median survival time for patients with oropharyngeal cancer were 55.4%,50.4%and 60.3 months,respectively.P16-immunostaining was scored positive in 39 samples(27.5%,39/142).Based on the seventh edition of AJCC staging,there were 4 patients in stageⅠ,17 patients in stageⅡ,27 patients in stageⅢand 94 patients in stageⅣ,respectively.However,there was no significant difference in survival between the patients with stageⅠ-Ⅱand those withⅢ-Ⅳ(5-year DSS:75.9%of stageⅠ-Ⅱpatients vs.52.2%of stageⅢ-Ⅳpatients;P=0.109).In comparison,22 patients were diagnosed as stageⅠ,24 were stageⅡ,27 were stageⅢand 69 were stageⅣusing the eighth edition.The 5-year DSS for patients with stageⅠ,Ⅱ,ⅢandⅣwas 88.4%,80.5%,73.2%and 29.1%,respectively.The overall difference was statistically significant(P=0.000).Conclusion:Compared with the seventh edition staging,the eighth edition of the AJCC oropharyngeal cancer staging system considers the prognosis of patients with different causes of oropharyngeal cancer,and can more accurately predict the prognosis of patients.