美国癌症联合委员会肿瘤分期手册第8版与第7版在下颌牙龈鳞癌T分期应用中的比较分析

Comparative analysis between the 8th and 7th editions of American Joint Committee on Cancer in the T staging for mandibular gingival squamous cell carcinoma

目的比较美国癌症联合委员会(AJCC)肿瘤分期手册第8版与第7版中的T分期对下颌牙龈鳞癌淋巴结转移的影响以及与肿瘤分化的相关性,从而了解第8版唇和口腔肿瘤TNM分期中增加浸润深度的临床意义。方法收集郑州大学第一附属医院手术切除的下颌牙龈鳞癌104例,按照AJCC肿瘤分期手册第8版(唇和口腔肿瘤TNM分期)和第7版(唇和口腔肿瘤TNM分期)的标准,分别进行T分期。分析比较2版T分期与下颌牙龈鳞癌淋巴结转移及肿瘤分化的相关性。观察第8版中增加浸润深度作为T分期指标对口腔鳞癌生物学特性的影响及临床意义。结果第8版T分期(T1期12.50%,T2期29.81%,T3期57.69%)比第7版T分期(T1期32.69%,T2期44.23%,T3期23.08%)呈上升趋势,特别是T3期患者明显增多(P<0.001)。第7版以T2期淋巴结转移率(36.96%)为最高,T1期(17.65%)次之,T3期(4.17%)最低(P=0.005)。第8版中T3期的淋巴结转移率较第7版明显增加(P=0.038)。依据第8版分期标准,T1、T2期以高分化为主(61.54%、54.84%),T3期以中分化多见(61.67%),并可见5例低分化患者(8.33%,P=0.049)。第7版T1、T3期以中分化为主(61.76%、62.50%),T2期以高分化多见(54.35%),T2、T3期可见低分化患者(2.17%、16.67%,P=0.006)。结论AJCC肿瘤分期手册第8版(唇和口腔肿瘤TNM分期)中增加浸润深度作为T分期标准更具科学性,随着T分期的增高其淋巴结转移更常见,预示更差的预后,第8版T分期对临床更具有指导意义。

Objective To compare the effect of different T stage according to the American Joint Committee on Cancer(AJCC)8th and 7th editions on lymph node metastasis of mandibular gingival squamous cell carcinoma and its correlation with tumor differentiation,so as to understand the clinical significance of increased depth of invasion in the TNM tumor stage of labial and oral cancer in the 8th edition.Methods The 104 cases of mandibular gingival cancer resected by surgery in the First Affiliated Hospital of Zhengzhou University were collected,and T staging was performed according to the standard of AJCC tumor stage manual 8th edition(TNM stage of labial and oral tumor)and 7th edition(TNM stage of labial and oral tumor).The influence of two TNM stages on lymph node metastasis of 104 cases of mandibular gingival squamous cell carcinoma and its relationship with tumor differentiation were analyzed and compared.The effect of increasing depth of invasion as T stage index in the 8th edition was observed on the biological characteristics of oral squamous cell carcinoma and its clinical significance was analyzed.Results The T stage of the 8th edition(T1 stage:12.50%,T2 stage:29.81%,T3 stage:57.69%)showed an increasing trend compared with the 7th edition(T1 stage:32.69%,T2 stage:44.23%,T3 stage:23.08%),especially in T3 stage(P<0.001).In the 7th edition,the transition rate of T2 stage(36.96%)was the highest,that of T1 stage was 17.65%,and that of T3 stage(4.17%)was the lowest(P=0.005).The lymph node metastasis rate of T3 stage in the 8th edition was significantly higher than that in the 7th edition(P=0.038).According to the standard of the 8th edition,T1 stage and T2 stage were characterized by high differentiation(61.54%,54.84%),while T3 stage was characterized by medium differentiation(61.67%),with 5 cases of low differentiation(8.33%,P=0.049).In the 7th edition,T1 stage and T3 stage were mainly moderately differentiated(61.76%,62.50%),while T2 stage was highly differentiated(54.35%),and T2 stage and T3 stage were poorly differentiated(2.17%,16.67%,P=0.006).Conclusion The increased depth of invasion in the 8th edition of AJCC(TNM stage of labial and oral tumors)as the standard of T stage has more scientific and higher clinical guiding significance.With the increase of T stage,the lymph node metastasis is more common and predicts worse prognosis.The 8th edition of T stage has more guiding significance for clinical practice.