肛门癌髂外淋巴结（N1b）转移的预后价值及新的分期分类系统的验证。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical colorectal cancer Pub Date : 2025-02-01 DOI:10.1016/j.clcc.2025.01.005

Hong'en Xu , Jie Zhuang , Chenyu Zhang , Weixuan Huang , Bingchen Chen , Bo'an Zheng , Tao Song

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引用次数: 0

摘要

目的评估髂外淋巴结（N1b）转移对肛门癌（AC）分期的影响，并在不修改现有标准的情况下完善肿瘤-结节-转移（TNM）系统：这项回顾性研究利用了2018年至2021年纳入监测、流行病学和最终结果（SEER）登记册的3815名肛门癌患者的数据。我们将 TNM 第 8 版和第 9 版与我们提出的系统进行了比较，重点关注总生存期（OS）和癌症特异性生存期（CSS）。我们采用卡普兰-梅耶生存分析和时间依赖性C指数来评估这3种分期系统：SEER登记系统仅发现42例N1b单发转移患者，淋巴结（LN）转移率随着T分期的升高而升高。从N1a到N1c亚组之间没有发现明显的生存差异，但N1a的OS和CSS均优于N1b+c（OS的危险比[HR] = 1.306，95%置信区间（CI）：1.011-1.687，P = .041；CSS的危险比[HR] = 1.432，95%置信区间（CI）：1.088-1.886，P = .011）。拟议的TNM系统将T 1N1M0重新分类为I期，将T3-T4的LN状态定义为IIIA和IIIB期，其预测准确性略有提高（C指数：OS为0.684 vs. 0.683；CSS为0.635 vs. 0.634）：结论：N1b 转移对 AC 分期的影响很小。结论：N1b 转移对 AC 分期的影响极小，我们将简化的 TNM 系统引入临床：M分期：远处转移灶作为 M1。T分期：T1 为 I 期，T2 为 II 期，T3-T4 为 III 期。N 分期：N 状态不影响 I 期；N 阴性为 A 期（IIA 或 IIIA），N 阳性为 B 期（IIB 或 IIIB）。

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Prognostic Value of External Iliac Lymph Node (N1b) Metastasis in Anal Carcinoma and Validation of a New Stage Grouping System

Objective

To assess the impact of external iliac lymph node (N1b) metastasis on anal carcinoma (AC) staging and refine the Tumor-Node-Metastasis (TNM) system without modifying existing criteria.

Methods

This retrospective study was performed utilizing the data of 3,815 patients with AC included in the Surveillance, Epidemiology, and End Results (SEER) registry from 2018 to 2021. We compared the TNM8th and 9th editions with our proposed system, focusing on overall survival (OS) and cancer-specific survival (CSS). The Kaplan–Meier survival analysis and time-dependent C-index measures were employed to evaluate the 3 staging systems.

Results

The SEER registry identified only 42 patients with solitary N1b metastasis, with lymph node (LN) metastasis rates rising with higher T stages. No significant survival differences were found among N1a to N1c subgroups, yet N1a showed better OS and CSS than N1b+c (hazard ratio [HR] = 1.306, 95% confidence interval (CI): 1.011–1.687, P = .041 for OS; HR = 1.432, 95% CI: 1.088–1.886, P = .011 for CSS). The proposed TNM system, reclassifying T 1N1M0 as stage I and defining T3-T4 with LN status as stages IIIA and IIIB, showed marginally improved predictive accuracy (C-index: 0.684 vs. 0.683 for OS; 0.635 vs. 0.634 for CSS).

Conclusions

N1b metastasis minimally affects AC staging. We introduce a simplified TNM system for clinical use:

M Staging: Distant metastasis presence as M1.

T Staging: T1 as stage I, T2 as stage II, T3-T4 as stage III.

N Staging: N status noncontributory for stage I; N negative as stage A (IIA or IIIA), N positive as stage B (IIB or IIIB).

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来源期刊

Clinical colorectal cancer 医学-肿瘤学

CiteScore

5.50

自引率

2.90%

发文量

审稿时长

27 days

期刊介绍： Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.