个性化四类分期可预测小肠腺癌患者的预后：一项国际开发和验证研究,EBioMedicine

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个性化四类分期可预测小肠腺癌患者的预后：一项国际开发和验证研究
EBioMedicine ( IF 9.7 ) Pub Date : 2020-09-24 , DOI: 10.1016/j.ebiom.2020.102979
Zi-Hao Dai ₁ , Qi-Wen Wang ₁ , Qing-Wei Zhang ₁ , Xia-Lin Yan ₂ , Thomas Aparicio ₃ , Yang-Yang Zhou ₄ , Huan Wang ₅ , Chi-Hao Zhang ₆ , Aziz Zaanan ₇ , Pauline Afchain ₈ , Yan Zhang ₁ , Hui-Min Chen ₁ , Yun-Jie Gao ₁ , Zhi-Zheng Ge ₁

Affiliation

Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Renji Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Institute of Digestive Disease;145 Middle Shandong Road, Shanghai 200001, China.
Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, School of Medicine, Tongji University, Shanghai, China.
Gastroenterology department, Saint Louis Hospital, APHP, University Paris Diderot, Paris, France.
Department of Rheumatology and Immunology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
Department of Biostatistics, The George Washington University, Washington, DC, United States.
Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Baoshan, 201999, Shanghai, China.
Gastroenterology and Digestive Oncology department, Georges Pompidou Hospital, APHP, Paris, France.
Oncology department, Saint Antoine Hospital, APHP, Paris, France.

背景

阳性淋巴结分类的对数赔率（LODDS）在预测小肠腺癌（SBA）患者的存活率方面优于^第8版N分期。这项研究的目的是开发和验证SBA的肿瘤，LODDS和转移（TLM）分期。

方法

1988-2010年间来自监测，流行病学和最终结果（SEER）数据库的总共1789例SBA患者，2011-2013年间来自SEER数据库的437例患者和来自多中心的166例患者分别分为发展，验证和测试队列。TLM分期是在开发队列中使用Ensemble算法对癌症数据进行聚类（EACCD）方法开发的。C指数用于评估TLM分期在预测癌症特异性生存（CSS）方面的表现，并与传统的^第8版TNM分期进行了比较。

发现

针对发展队列设计的四类TLM分期在预测发展队列CSS（0.682 vs. 0.650，P <0.001），验证队列（0.682 vs. 0.654，P = 0.022）和测试方面显示出比TNM分期更高的区分能力队列（0.659 vs. 0.611，P = 0.023）。TLM分期仍呈其较高的预测效力比8^个在TNM分期II / III期患者或患者的淋巴结收率TNM小于8。

解释

TLM分期显示出比第8^次TNM分期更好的预后性能，尤其是TNM II / III期或淋巴结收率低于8分的患者，因此可以补充SBA患者的TNM分期。

资金

在“致谢”部分中找到了为这项研究做出贡献的供资机构的完整列表。

"点击查看英文标题和摘要"

Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study

Background

Log odds of positive lymph nodes (LODDS) classification showed superiority over 8^th edition N staging in predicting survival of small bowel adenocarcinoma (SBA) patients. The aim of this study was to develop and validate the Tumor, LODDS, and Metastasis (TLM) staging of SBA.

Methods

Totally 1789 SBA patients from the Surveillance, Epidemiology, and End Results (SEER) database between 1988–2010, 437 patients from SEER database between 2011–2013 and 166 patients from multicenters were categorized into development, validation and test cohort, respectively. The TLM staging was developed in the development cohort using Ensemble Algorithm for Clustering Cancer Data (EACCD) method. C-index was used to assess the performance of the TLM staging in predicting cancer-specific survival (CSS) and was compared with the traditional 8^th edition TNM staging.

Findings

Four-category TLM staging designed for the development cohort showed higher discriminatory power than TNM staging in predicting CSS in the development cohort (0.682 vs. 0.650, P < 0.001), validation cohort (0.682 vs. 0.654, P = 0.022), and test cohort (0.659 vs. 0.611, P = 0.023), respectively. TLM staging continued to show its higher predictive efficacy than the 8^th TNM in TNM stage II/III patients or in patients with lymph node yield less than 8.

Interpretation

TLM staging showed a better prognostic performance than the 8^th TNM staging especially TNM stage II/III or patients with lymph node yield less than 8 and therefore, could serve to complement the TNM staging in patients with SBA.