随着UICC/AJCC第9版TNM分期体系的实施,胃肠道肿瘤病理报告正由传统叙述式模式向结构化、要素化/字段化及临床路径导向模式转变。本文围绕UICC/AJCC第9版TNM分期在食管、胃、小肠、阑尾、结直肠及肛管肿瘤中的关键更新要点,重点阐述治...随着UICC/AJCC第9版TNM分期体系的实施,胃肠道肿瘤病理报告正由传统叙述式模式向结构化、要素化/字段化及临床路径导向模式转变。本文围绕UICC/AJCC第9版TNM分期在食管、胃、小肠、阑尾、结直肠及肛管肿瘤中的关键更新要点,重点阐述治疗后分期以“残余活肿瘤细胞”为依据、结直肠癌肿瘤沉积(tumor deposits,TD)与壁外血管侵犯(extramural vascular invasion,EMVI)/神经周围侵犯(perineural invasion,PNI)的并行报告原则、直肠环周切缘(circumferential resection margin,CRM)与肿瘤退缩分级(tumor regression grade,TRG)的评估标准、阑尾黏液性肿瘤M1a/M1b分层依据以及分子分层在治疗路径中的应用等内容。同时结合国际癌症报告联盟(International Collaboration on Cancer Reporting,ICCR)与北美病理医师学会(College of American Pathologists,CAP)等数据集,提出结构化病理报告核心字段/要素设置及科室实施策略,旨在推动TNM分期更新在临床实践中的规范化和均质化应用,并提升病理报告对多学科精准诊疗的支持能力。展开更多
Objective： We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer （AJCC） staging system for luminal A breast cancer. Methods： Using both the anatomic...Objective： We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer （AJCC） staging system for luminal A breast cancer. Methods： Using both the anatomic and prognostic staging in the 8th edition of AJCC cancer staging system, we restaged patients with luminal A breast cancer treated at the Breast Disease Center, Peking University First Hospital from 2008 to 2014. Follow-up data including 5-year disease free survival （DFS）, overall survival （OS） and other clinic-pathological data were collected to analyze the differences between the two staging subgroups. Results： This study included 421 patients with luminal A breast cancer （median follow-up, 61 months）. The 5- year DFS and OS rates were 98.3% and 99.3%, respectively. Significant differences in 5-year DFS but not OS were observed between different anatomic disease stages. Significant differences were observed in both 5-year DFS and O S between different prognostic stages. Application of the prognostic staging system resulted in assignment of 175 of 421 patients （41.6%） to a different group compared to their original anatomic stages. In total, 102 of 103 patients with anatomic stage IlA changed to prognostic stage IB, and 24 of 52 patients with anatomic stage lib changed to prognostic stage IB, while 1 changed to prognostic stage liIB. Twenty-two of 33 patients with anatomic stage IliA were down-staged to IlA when staged by prognostic staging system, and the other 11 patients were down-staged to liB. Two patients with anatomic stage IIIB were down-staged to IliA. Among seven padents with anatomic stage IIIC cancer, two were down-staged to IliA and four were down-staged to stage I]IB. Conclusions： The 8th edition of AJCC prognostic staging system is an important supplement to the breast cancer staging system. More clinical trials are needed to prove its ability to guide selection of proper systemic therapy and predict prognosis of breast cancer.展开更多
Objective:To validate the eighth edition of the AJCC staging system in patients with pancreatic adenocarcinoma receiving only stereotactic body radiation therapy and chemotherapy,and to propose modifications to improv...Objective:To validate the eighth edition of the AJCC staging system in patients with pancreatic adenocarcinoma receiving only stereotactic body radiation therapy and chemotherapy,and to propose modifications to improve prognostic accuracy.Methods:Patients with pathologically confirmed pancreatic adenocarcinoma without metastasis who were undergoing only chemoradiotherapy were included and staged according to the seventh and eighth editions of the AJCC staging system.Meanwhile,another group of stage T4 patients from the above enrollment with only portal vein involvement with or without tumor thrombi(PV±PVTT)were retrieved for survival comparisons.Modifications were proposed according to the survival comparisons.A cohort from the SEER database was used for external validation of the modified staging system.Results:A total of 683 patients were included.Patients with N2 or N1 but different T stages had significantly different survival outcomes according to the eighth edition.The survival of patients with(PV±PVTT)was comparable to that of patients with T4 tumors.The concordance index of the seventh and eighth editions,and the modified staging system was 0.744(95%CI:0.718—0.769),0.750(95%CI:0.725—0.775),and 0.788(95%CI:0.762-0.813),respectively.For external validation,the concordance index was 0.744(95%CI:0.718-0.770),0.750(95%CI:0.724-0.776),and 0.788(95%CI:0.762-0.814),respectively.Conclusions:The modified staging system is suggested to have the m ost accurate prognostic value.Hence,PV土PVTT should be added to the definition of T4 tumors regardless of tumor size.Patients with N2 or N1 in different T stages could be regrouped into different substages.Additionally,stage III should be subclassified into IIIA(T3N 2 and T4N 0)and IIIB(T4N 1-2).展开更多
文摘随着UICC/AJCC第9版TNM分期体系的实施,胃肠道肿瘤病理报告正由传统叙述式模式向结构化、要素化/字段化及临床路径导向模式转变。本文围绕UICC/AJCC第9版TNM分期在食管、胃、小肠、阑尾、结直肠及肛管肿瘤中的关键更新要点,重点阐述治疗后分期以“残余活肿瘤细胞”为依据、结直肠癌肿瘤沉积(tumor deposits,TD)与壁外血管侵犯(extramural vascular invasion,EMVI)/神经周围侵犯(perineural invasion,PNI)的并行报告原则、直肠环周切缘(circumferential resection margin,CRM)与肿瘤退缩分级(tumor regression grade,TRG)的评估标准、阑尾黏液性肿瘤M1a/M1b分层依据以及分子分层在治疗路径中的应用等内容。同时结合国际癌症报告联盟(International Collaboration on Cancer Reporting,ICCR)与北美病理医师学会(College of American Pathologists,CAP)等数据集,提出结构化病理报告核心字段/要素设置及科室实施策略,旨在推动TNM分期更新在临床实践中的规范化和均质化应用,并提升病理报告对多学科精准诊疗的支持能力。
基金supported by research grants from the Beijing Municipal Commission of Health and Family Planning(No.2009-1011)the Beijing Municipal Science and Technology Commission(No.D090507043409010 and Z131107002213007)the Precision Medicine Special Project of National Key Research and Development Program(No.2016YFC0901302)
文摘Objective： We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer （AJCC） staging system for luminal A breast cancer. Methods： Using both the anatomic and prognostic staging in the 8th edition of AJCC cancer staging system, we restaged patients with luminal A breast cancer treated at the Breast Disease Center, Peking University First Hospital from 2008 to 2014. Follow-up data including 5-year disease free survival （DFS）, overall survival （OS） and other clinic-pathological data were collected to analyze the differences between the two staging subgroups. Results： This study included 421 patients with luminal A breast cancer （median follow-up, 61 months）. The 5- year DFS and OS rates were 98.3% and 99.3%, respectively. Significant differences in 5-year DFS but not OS were observed between different anatomic disease stages. Significant differences were observed in both 5-year DFS and O S between different prognostic stages. Application of the prognostic staging system resulted in assignment of 175 of 421 patients （41.6%） to a different group compared to their original anatomic stages. In total, 102 of 103 patients with anatomic stage IlA changed to prognostic stage IB, and 24 of 52 patients with anatomic stage lib changed to prognostic stage IB, while 1 changed to prognostic stage liIB. Twenty-two of 33 patients with anatomic stage IliA were down-staged to IlA when staged by prognostic staging system, and the other 11 patients were down-staged to liB. Two patients with anatomic stage IIIB were down-staged to IliA. Among seven padents with anatomic stage IIIC cancer, two were down-staged to IliA and four were down-staged to stage I]IB. Conclusions： The 8th edition of AJCC prognostic staging system is an important supplement to the breast cancer staging system. More clinical trials are needed to prove its ability to guide selection of proper systemic therapy and predict prognosis of breast cancer.
基金grants from the Special Project of Ministry of Science and Technology(Grant No.2017 YFC0113104)We thank Dr.Jiuhong Chen for helpful comments,Dr.Fabienne Hirigoyenberry and Dr.Huijun Chen,for language editing and LinkDoc for their constructive advice in patient follow-up.
文摘Objective:To validate the eighth edition of the AJCC staging system in patients with pancreatic adenocarcinoma receiving only stereotactic body radiation therapy and chemotherapy,and to propose modifications to improve prognostic accuracy.Methods:Patients with pathologically confirmed pancreatic adenocarcinoma without metastasis who were undergoing only chemoradiotherapy were included and staged according to the seventh and eighth editions of the AJCC staging system.Meanwhile,another group of stage T4 patients from the above enrollment with only portal vein involvement with or without tumor thrombi(PV±PVTT)were retrieved for survival comparisons.Modifications were proposed according to the survival comparisons.A cohort from the SEER database was used for external validation of the modified staging system.Results:A total of 683 patients were included.Patients with N2 or N1 but different T stages had significantly different survival outcomes according to the eighth edition.The survival of patients with(PV±PVTT)was comparable to that of patients with T4 tumors.The concordance index of the seventh and eighth editions,and the modified staging system was 0.744(95%CI:0.718—0.769),0.750(95%CI:0.725—0.775),and 0.788(95%CI:0.762-0.813),respectively.For external validation,the concordance index was 0.744(95%CI:0.718-0.770),0.750(95%CI:0.724-0.776),and 0.788(95%CI:0.762-0.814),respectively.Conclusions:The modified staging system is suggested to have the m ost accurate prognostic value.Hence,PV土PVTT should be added to the definition of T4 tumors regardless of tumor size.Patients with N2 or N1 in different T stages could be regrouped into different substages.Additionally,stage III should be subclassified into IIIA(T3N 2 and T4N 0)and IIIB(T4N 1-2).
