摘要目的 验证第8版美国癌症联合委员会(AJCC)分期系统是否能指导对T1～2N1M0乳腺癌改良根治术后患者进行更加准确的预后评估.方法 收集1 823例T1～2N1M0乳腺癌女性患者的临床病理和随访资料,患者均接受了全乳切除术和腋窝淋巴结清扫术,且未行新辅助化疗.根据第8版AJCC分期进行重新分期.预后影响因素的单因素分析采用Log rank检验,多因素分析采用Cox比例风险模型回归分析.采用受试者工作特征( ROC)曲线分析和一致性指数( c?index)比较第7版AJCC分期和第8版AJCC分期预后分期的准确性.结果 全组患者5年局部区域复发( LRR)率为6.0%,5年远处转移(DM)率为11.5%,5年无病生存(DFS)率为85.0%,5年总生存( OS)率为93.1%.Cox回归分析显示,第7版AJCC分期和孕激素受体( PR)状态是LRR、DM、DFS和OS的独立预后因素(均P＜0.05).与第7版AJCC分期比较,根据第8版AJCC分期进行重新分期后,全组有1 278例(70.1%)患者被分至不同的期别,其中1 088例(85.1%)被分至了更低的期别,190例(14.9%)则被分至了更高的期别.按第8版AJCC分期的ⅠA期、ⅠB期、ⅡA期、ⅡB期和ⅢA期患者LRR、DM、DFS和OS差异均有统计学意义(均P＜0.001).第8版AJCC分期的c?index明显高于第7版AJCC分期(P＜0.001).结论 与第7版AJCC分期比较,第8版AJCC分期系统对于全乳切除的T1～2N1M0乳腺癌患者预后评估准确性更高,具有更好的临床治疗指导价值.

abstractsObjective To validate whether the prognostic stage groups by the 8th edition of the American Joint Committee on Cancer (AJCC) staging system provides improved prognostic accuracy in T1?2N1M0 postmastectomy breast cancer patients compared to 7th edition. Methods a total of 1 823 female patients with T1?2N1M0 breast cancer who underwent mastectomy and axillary lymph node dissection without neoadjuvant chemotherapy were analyzed and restaged according to 8th edition. Univariate analysis of prognostic factors was evaluated by using log?rank test. Multivariate analysis was estimated by using the Cox proportional hazards model. The prognostic accuracy of the two staging systems was compared using receiver operating characteristic ( ROC ) analyses and the concordance index ( C?index ). Results 5?year locoregional recurrence rate (LRR) for the whole group was 6.0%, 5?year distant metastasis (DM) rate was 11.5%, 5?year disease?free survival (DFS) was 85.0%, and 5?year overall survival (OS) was 93.1%. Cox analysis showed that 7th edition of the AJCC staging system and progesterone receptor status were independent risk factors for LRR, DM, DFS and OS (P＜0.05). Compared with stage by 7th edition, 1 278 (70.1%) were assigned to a different prognostic stage group: 1 088 ( 85.1%) to a lower stage and 190 (14.9%) to a higher stage. LRR, DM, DFS and OS were significantly different between prognostic stageⅠA,ⅠB,ⅡA,ⅡB and ⅢA according to 8th edition of the AJCC staging system(P＜0.001). Prognostic stage had significantly higher C?indexes and provided better estimation of prognosis compared to stage by 7th edition of the AJCC staging system ( P＜0.001). Conclusion The prognostic stage groups of 8th edition AJCC staging system has superior prognostic accuracy compared to 7th edition in T1?2N1M0 breast cancer, and has better clinical therapeutic guidance value.