食管癌新旧分期系统预后价值的比较

目的:比较第7 版和第6 版AJCC食管癌分期系统对可切除的食管鳞癌患者的预后评估的差异。方法:选取天津医科大学附属肿瘤医院1999年1 月至2004年12月间398 例食管鳞状细胞癌术后有完整资料患者的临床病理和5 年随访资料，通过Kaplan-Meier 生存曲线法描述生存过程，Log-Rank检验不同分期的生存率的差异，χ2检验比较组间差异。结果:按照AJCC第6 版及第7 版两种不同的TNM分期方法对398 例患者的临床病理结果进行分期，总的5 年生存率为26.9% 。新分期后，由于转移淋巴结数目和肿瘤分化程度的标准不同，Ⅰ期及Ⅳ期的例数均有所增加，各期别生存差异较第6 版更加显著。其5 年生存率分别为62.5% ，33.9% ，15% ，3.4% 。结论:AJCC食管癌第7 版分期能够更好的反映食管癌术后患者的预后，转移淋巴结数目的对预后的影响更显重要。 

Comparison of the Prognostic Values between the Sixth and Seventh Editions of the AJCC Staging System in Postoperative Esophageal Cancer Patients

Objective:To evaluate the prognostic significance of the7th edition AJCC TNM staging system and to com -pare the difference between the 6th and 7th editions of the AJCC staging system in postoperative esophageal squamous cancer (ESCa) patients. Methods:Clinicopathologic and 5-year follow-up data of 398 ESCa patients, who received primary surgical resection during a period between January1999 and December 2004, were included. Survival analysis was con-ducted using the Kaplan-Meier curve. Log-Rank test was conducted to assess the difference between the two staging sys-tems. The χ2 test was used for comparing the difference between the groups. Results: The clinicopathologic results of these patients were staged based on the TNM staging of the two editions. The average five-year survival rate for the entire cohort was 26.9%. Using the new staging system, the number of phase Ⅰand phase Ⅳcases is increased because of the definition in the number of metastasized lymph nodes and degree of tumor differentiation. The differences in survival in the stag -es become more distinct. In the 7th edition, the 5-year survival rate is 62.5%,33.9%,15%, and3.4%, for stagesⅠ, Ⅱ, Ⅲ and Ⅳ, respectively, showing significant differences among the survival rates of cases at various stages. Conclusions: The 7th edition AJCC TNM staging system is better able to stage the prognosis of ESCa patients compared to its previous edition. Using this edition, the number of metastasized lymph nodes can be clearly estimated and this is significant for deter -mining the correct prognosis.