制订2009第7版食管癌TNM分期标准

目的报告参与制订2009第7版食管癌国际TNM分期的国际协作研究结果。方法收集全世界13个协作单位的4628例食管癌单纯切除病例的资料，采用全新的统计学模型，综合各预后影响因素反向归纳至最合理的TNM分期。结果全组总的1、5、10年死亡率分别为78％、42％、31％。远期生存的主要影响因素为肿瘤侵犯深度、淋巴结转移数目、有无远处转移、肿瘤的组织学类型和分化程度。将其优化组合后新的TNM分期中T1应细化为T1a和T1b，T4应细化为T4a和T4b，N应当根据淋巴结的转移数目分级，M1的亚分级应当取消，且应加入肿瘤组织学类型（H）和分化程度（G）因素。结论2009第7版食管癌分期标准重新定义了T、N、M，并分期为0、Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb、Ⅳ期，可更好地预测食管癌患者手术切除治疗的预后。

Defining AJCC/UICC Esophageal Cancer TNM Staging 7th Edition (2009)

Objective The TNM Classification of Malignant Tumors jointly published by American Joint Committee on Cancer （AJCC） and Union Internationale Contren le Cancer （UICC） has been widely accepted as the ＂gold standard＂ for cancer treatment and research. Every few years, it is revised to reflect the advantage and progression in this field. As the only invited collaborator from mainland of China, the aim of this study is to introduce the participation of a worldwide collaboration to define the esophageal cancer staging system, 7th edition for 2009, sponsored by National Institutes of Health （NIH）. Methods Total 4 628 patients with esophageal cancer who underwent a simple esophagectomy were recruited from 13 collaborating centers around the world, including 9 from North America, 2 from Europe and 2 from Asia. A new statistical model called random survival forests was applied to regressively identify and group prognostic factors into the optimal TNM staging combinations. Results The 1, 5, and 10 years survival were 78%, 42% and 31%, respectively. The main prognostic factors for long-term survival were the depth of primary tumor invasion （T）, number of regional lymph node involvement （N）, distant metastasis （M）, histological type （H） and the grade of differentiation （G） of the tumor. For refining the TNM staging, T1 should be further subclassified as T1a and T1b, N should be defined according to the number of positive lymph nodes, the subclassification of M1 into M1a and M1b is unnecessary and should be merged. Moreover, factors H and G should be included into the system. Conclusion The newly refined esophageal cancer staging system redefines T, N, M, and added G and H. The resulted grouping as Stage 0, Ⅰa, Ⅰb, Ⅱ, Ⅲa, Ⅲb, and Ⅳ is more practical and can better predict the prognosis of patients with esophageal carcinoma treated by esophagectomy. The result is planned to be published as the 7th edition of esophageal cancer staging system in 2009 jointly by AJCC and UICC.