AJCC第7版与第6版胃癌TNM分期的比较:一项基于预后分析的918例中国胃癌人群的回顾性研究

目的:本研究旨在评价美国癌症联合会(American Joint Committee on Cancer,AJCC)第7版胃癌TNM分期系统在判断预后方面是否优于AJCC第6版胃癌TNM分期系统.方法:对2003年1月-2008年12月单一中心的918例胃癌患者分别采用AJCC第6版和第7版胃癌TNM分期系统进行重新分期,采用单因素和多因素分析评价这2种胃癌TNM分期系统在判断预后中的价值.采用Akaike信息标准(Akaike's Information Criterion,AIC)评价这2个分期系统的优劣.结果:AJCC第7版胃癌TNM分期系统中,T、N和M分期亚组的总生存时间差异有统计学意义.对患者进行Ⅰ～Ⅳ期临床分期,则无论是按照AJCC胃癌TNM分期系统第6版还是第7版,Ⅰ～Ⅳ期这4条生存曲线的差异均有统计学意义(P值均为0.000)；按照AJCC第7版胃癌TNM分期系统的8个亚分期,ⅠA期和ⅠB期、ⅠB期和Ⅱ A期、Ⅱ B期和Ⅲ A期、Ⅲ A期和Ⅲ B期以及Ⅲ B期和Ⅲ C期的生存曲线差异均无统计学意义(P=0.643、P=0.267、P=0.534、P=0.124、P=0.174).AJCC第7版胃癌TNM分期系统的AIC值小于第6版.结论:AJCC第7版胃癌TNM分期系统在预测预后价值方面要优于第6版,但前者的优势十分有限,且存在一定缺陷.

Comparison of the 7th and 6th edition AJCC TNM staging systems for gastric cancer: analysis of prognosis in a retrospective review of 918 patients at a single institution in China

Objective:To evaluate the prognostic priority of the 7th edition AJCC (American Joint Committee on Cancer) TNM staging system for gastric carcinoma compared with the 6th edition in Chinese population. Methods:A total of 918 patients with gastric carcinoma from a single institution between January 2003 and December 2008 in China were staged using the 6th edition and the 7th edition AJCC TNM staging systems. The univariate and multivariate analyses were applied to evaluate the value of the two staging systems in prognostic prediction for gastric carcinoma. The AIC (Akaike’s Information Criterion) was used to determine which is better between the two staging systems. Results:Significant differences in overall survival were observed according to the T, N and M substages using the 7th edition AJCC TNM staging system. The Kaplan-Meier survival curves showed a good discriminatory ability among stages Ⅰ through Ⅳ in both the 6th and 7th edition staging systems (P = 0.000). There were similar survival curves between substagesⅠA andⅠB (P = 0.643), ⅠB and ⅡA (P = 0.267), ⅡB and ⅢA (P = 0.534), ⅢA and ⅢB (P = 0.124), and ⅢB and ⅢC (P = 0.174) when the patients were classified into eight substages according to the 7th edition AJCC TNM staging system. The AIC value of the 7th edition staging system was smaller than the 6th edition staging system. Conclusion:The 7th edition AJCC TNM staging system is superior to the 6th edition staging system. But the advantage of the new 7th edition staging system is very limited and it presents some deficiencies.