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The impact of tumor deposits on colonic adenocarcinoma AJCC TNM staging and outcome.

肿瘤沉积物对结肠腺癌AJCC/TNM分期及预后的影响。

Jin M,Roth R,Rock JB,Washington MK,Lehman A,Frankel WL

Abstract

The definition of tumor deposits (TDs) in colonic adenocarcinoma has been modified in different editions of the AJCC/TNM staging system. Studies have shown that the presence of TD is associated with advanced tumor growth and poor prognosis. Most of these data were obtained in patients with simultaneous lymph node (LN) metastases. Reports focusing on the impact of TD in patients without LN metastasis are limited. We retrospectively restaged all right-sided colonic adenocarcinomas over a 10-year period using criteria from the fifth, sixth, and seventh AJCC edition. We compared the number of tumor nodule interpreted as LN and TD in each edition and evaluated the stage migration caused by TD definition change. We then assessed clinical significance of TD in the AJCC seventh edition by comparing 5-year overall survival of N1c patients versus other N category (N0, N1, N2) patients with similar T and M status. We showed that the average number of tumor nodules interpreted as LNs per case and the number of cases with positive LNs were significantly decreased with the seventh edition compared with fifth/sixth; however, numbers of cases with TDs and <12 LNs were significantly increased with the seventh edition compared with fifth/sixth. These changes, however, resulted in minimal effects on the final stage grouping. Our survival analysis showed that N1c patients had significantly worse survival compared with N0 patients. Although not statistically significant, the hazard ratios indicated that the N1c group might have worse survival than the N1 group and better survival than the N2 group. Therefore, we conclude that TDs predict patient outcome at least similarly to positive LNs.

摘要


肿瘤沉积物(TDs)的定义在不同版本的结肠腺癌AJCC/TNM分期均有修动。研究表明,肿瘤沉积物与进展期肿瘤的生长及不良预后有关。而现有研究收集的数据多数都是来自有淋巴结(LN)同步转移的患者。研究肿瘤沉积物对无淋巴结转移患者影响的报道非常有限。在此,我们用第五、第六和第七版AJCC分期标准回顾性研究10年期间的所有右半结肠腺癌患者。使用这三个AJCC分期标准,对比分析可看做是淋巴结的肿瘤结节数目和肿瘤沉积物的变化,同时评价因为肿瘤沉积物定义变化所引起的AJCC分期标准的相应变动。同时,在第七版AJCC分期,选择相同T、M分期,比较N1c分期及其它N分期(N0, N1, N2)患者的5年生存率,进一步评估肿瘤沉积物的临床意义。我们的研究表明:第七版相较于第五/六版AJCC分期,每个患者中可看做是淋巴结的肿瘤结节平均数量及所有患者淋巴结阳性数显著下降;然而,含有肿瘤沉积物及淋巴结数量<12个的患者人数显著增加。但是,这些变化对最终分期的影响很小。我们的生存分析显示N1c分期患者比N0分期预后差。虽无统计学意义,HR值表明N1c组患者预后比N1组差,但比N2组好。因此,我们得出结论,肿瘤沉积物可预测患者的预后,几乎可与淋巴结阳性相媲美。


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