| Objective: The Tumor-Node-Metastasis staging system of the tumorshave a crucial role which is related to the doctor for the judgment andtreatment of the illness, estimation of the prognosis and guidance the besttreatment for the same period but other tumors. The international acceptedTNM staging system is formulated by AJCC and UICC. The6th Edition of theTNM staging system that made in2002is the same as the5th edition thatmade in1997, had been used more than10years. This edition staging systemhad been recognized and spread in use process, but with the development ofmedical technology, there are many problems and disputes, it can't satisfy thecurrent clinical treatment and the requirement of accuracy of staging inpatients with cancer of the esophagus, so, the formulation of new esophagealstaging system is imperative. The7th edition of the TNM staging system waspublished in2009and officially implemented in January of2010that is verydifferent from ever before. We aim to compare the difference between the6thand7th editions of the TNM staging system in esophageal cancer to evaluateits predictive ability and the prognostic significance as to guide the applicationof clinical.Method: This research collected cases of esophageal cancer patients whohad received surgery treatment and confirmed by histopathology in hospital ofHe bei Medical University Fourth between January2007to December2008excluded gender, age, address, smoking history, drinking history, familyhistory, the number of family history, different cancer location, histologygrade, pathological type, tumor size, infiltration depth, lesions lymph nodes,up and down the state, vascular tumor thrombus, etc, and got756cases ofsurgical patients' cases. Carrying on at one least follow-up (telephonefollow-up,hospital review and letters)to all cases. In the study Operation time is as the starting point, patient death or lost follow-up or last follow-up as theend, death due to cancer as the study outcome, the follow-up deadline wasOctober31,2011.During the follow-up,the patients who still alive werecounted as censored date.Patients were staged using the6th and7th edition staging systems.Survival analysis was performed with Kaplan-Meier method, the Log-rank testwas used to compare survival rate, statistical significance and the differencebetween each period in two edition staging systems were judged by P value.the Log-rank test was used to univariate analysis and COX regression modelwas used to multivariate analysis. P﹤0.05is used as the significance test level.SPSS19.0statistical software was used for statistical analysis.Results:756cases were included in the research and were staged using the6thand7th edition staging systems.1Staging change: According to the7th edition staging systems, comparedto the6th edition,the number of T,N,M and TNM staging were changed.89cases of T1in the6th edition changed to30cases of T1a and59cases of T1b,56cases of T4in the6th edition changed to T4a,272cases of N1in the6thedition changed to185cases of N1,75cases of N2and12cases of N3.73cases of stage I in the6th edition changed to65cases of stage IA and8casesof stage IB,385cases of stage IIA in the6th edition changed to132cases ofstage IB,233cases of stage IIA and20cases of stage IIB,53cases of stageIIB in the6th edition changed to38cases of stage IIB, and15cases of stageIIIA,242cases of stage III in the6th edition changed to150cases of stageIIIA,50IIIB cases of stage and42cases of stage IIIC.2The difference between adjacent each period: Compared by theKaplan-Meier method, in the6th edition staging system, the Kaplan-Meierplots showed there were similar survival curves between stages IIB and III,which not showed in the7th edition Kaplan-Meier plots. It means the7thedition staging system is better than the6th edition. The comparison betweenadjacent of survival, In the6th edition staging system, when classified as all five substages, there were similar survival curves between stages IIB and III.In the7th edition staging system, when classified as all eight substages, therewere similar survival curves between stages IIIB and IIIC, between stages IIAand IIB that even worse than the6th edition.3The survival result: In the study,according to6th edition staging thepatients'1,3,4year overall survival rate were respectively98.6%,89.8%,83.3%(stageI),92.2%,66.3%,57.8%(stageIIA),79.2%,37.4%,14.6%(stageIIB),67.7%,26.3%,24.7%(stageIII)and0,0,0(stageIV). According to7th editionstaging the patients'1,3,4year overall survival rate were respectively98.5%,90.2%,83.1%(stageIA),95.7%,75.6%,67.4%(stageIB),91.4%,61.5%,51.8%(stageIIA),82.8%,51.5%,38.2%(stageIIB),75.8%,30.9%,27.0%(stageIIIA),52.4%,19.3%,16.0%(stageIIIB),52.0%,14.3%,11.2%(stageIIIC)and0,0,0(stageIV).The two editions are different in reflecting the prognosis of patients andthe7the dition is more elaborate and accurate than the6th.4Prognostic factors: In the univariate analysis, the number of family history,different cancer location, histology grade, vascular tumor thrombus,infiltration depth, lesions lymph nodes were the factors impacted overallsurvival and disease free survival. Different cancer location, infiltration depth,lesions lymph nodes and site for metastases were significant prognostic factorson survival in multivariate analysis.Conclusion:1Compared to the6th edition staging systems, the7th edition is moreelaborate in reflecting the prognosis of patients, also, it has a improvement injudging and predict the prognosis of patients,which is worth to promoting inthe clinical work.Meanwhile, there are some problems, the division of stageIIA and IIB is even worse than the6th edition and the division of stage IIIBand IIIC is not very ideal,which are to be further improved.2COX regression multivariate analysis showed that, different cancerlocation, infiltration depth, lesions lymph nodes and site for metastases werefacters in impacting the overall survival and disease-free survival ofesophageal carcinoma. |
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