AJCC第7版与第8版分期对乳腺癌患者预后预测的比较分析

doi:10.19401/j.cnki.1007-3639.2019.01.007

摘要/Abstract

摘要： 背景与目的：美国癌症联合委员会（American Joint Committee on Cancer，AJCC）第8版乳腺癌分期在传统解剖因素基础上，结合生物标志物，建立了一种全新的乳腺癌预后分期系统。该研究旨在分析AJCC第8版乳腺癌分期的临床应用价值。方法：分析222例乳腺癌根治术后出现复发转移的患者，按照AJCC第7版解剖分期：肿瘤（tumor，T）分期、淋巴结（node，N）分期、转移（metastasis，M）分期，和第8版预后分期标准进行初诊状态再分期，比较不同标准分期的差异及与预后的关系，生存分析采用Kaplan-Meier方法，log-rank法检验无病生存期（disease-free survival，DFS）的差异。结果：按照AJCC第7版分期标准，ⅠA、ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期的患者分别为34例（15.3%）、0例（0.0%）、73例（32.9%）、26例（11.7%）、45例（20.3%）、4例（1.8%）和40例（18.0%）；按照AJCC第8版预后分期标准，ⅠA、ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期的患者分别为47例（21.2%）、35例（15.8%）、55例（24.8%）、17例（7.7%）、25例（11.3%）、30例（13.5%）和13例（5.9%），差异有统计学意义（P=0.000）。分期变化主要有：第7版Ⅰ期细分为第8版ⅠA和ⅠB期；第7版ⅡA期细分为第8版ⅠA、ⅠB和ⅡA期；第7版ⅡB期细分为第8版ⅠA、ⅠB、ⅡA、ⅡB和ⅢA期；第7版ⅢA期细分为第8版ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期；第7版ⅢB和ⅢC期细分为第8版ⅢA、ⅢB和Ⅲc期。AJCC第7版TNM分期和第8版预后分期与患者DFS比较差异均有统计学意义（P=0.002和0.001），第8版预后分期ⅢB和ⅢC期亚组的DFS更为准确。结论： AJCC第8版预后分期能够准确预测乳腺癌患者的预后。

关键词: 乳腺肿瘤, 分期, 预后

Abstract: Background and purpose: The American Joint Committee on Cancer (AJCC) 8th edition cancer staging manual introduced a new prognostic staging system for breast cancer incorporating biological markers in addition to traditional anatomical factors. The purpose of this study was to determine the clinical value of the 8th edition AJCC classification for breast cancer. Methods: The data from 222 recurrent or metastatic cases of breast cancer after operation were analyzed. Cancer staging was determined using the 7^th edition anatomical staging criteria including tumor (T), node (N) and metastasis (M), and was further evaluated using 8^thedition prognostic classification. We compared the two staging systems and their relations to prognosis. Kaplan-Meier and log-rank tests were used for univariate comparison of disease-free survival (DFS). Results: The percentages of ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 34 (15.3%), 0 (0.0%), 73 (32.9%), 26 (11.7%), 45 (20.3%), 4 (1.8%) and 40 (18.0%) according to AJCC 7th edition anatomical TNM staging system, respectively. The percentages of ⅠA, ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC were 47 (21.2%), 35 (15.8%), 55 (24.8%), 17 (7.7%), 25 (11.3%), 30 (13.5%) and 13 (5.9%) according to AJCC 8th edition prognostic staging system, respectively. The difference between the two staging groups was significant (P=0.000). Changes occurred mainly in the following categories: the 7^thedition ⅠA was divided into the 8^th edition ⅠA and ⅠB categories; ⅡA was divided into ⅠA, ⅠB and ⅡA; ⅡB was divided into ⅠA, ⅠB, ⅡA, ⅡB and ⅢA; ⅢA was divided into ⅠB, ⅡA, ⅡB, ⅢA, ⅢB and ⅢC; and both the 7^th edition ⅢB and ⅢC were divided into the 8^th edition ⅢA, ⅢB and ⅢC categories. There was statistically significant difference in DFS between stage groups according to both AJCC 7^thedition TNM and 8^th edition prognostic staging systems (P=0.002 and 0.001), and the DFS in ⅢB and ⅢC groups according to AJCC 8th edition prognostic staging system was more accurate compared with AJCC 7^th edition. Conclusion: The 8^th edition AJCC prognostic classification could exactly predict the prognosis of breast cancer.

Key words: Breast carcinoma, Staging system, Prognosis

张凤春,左丽,马越,等. AJCC第7版与第8版分期对乳腺癌患者预后预测的比较分析[J]. 中国癌症杂志, 2019, 29(1): 45-51.

ZHANG Fengchun, ZUO Li, MA Yue, et al. Comparison of the prognostic classifications between the 7^thand 8^th editions of AJCC cancer staging manual for breast cancer[J]. China Oncology, 2019, 29(1): 45-51.

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