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Survival outcomes used to generate version 9 American Joint Committee on Cancer staging system for anal cancer. ​

文献信息 ​

DOI10.3322/caac.21780
PMID37114458
期刊CA: a cancer journal for clinicians
影响因子232.4
JCR 分区Q1
发表年份2023
被引次数13
关键词美国癌症联合委员会（AJCC）第9版，肛门癌，癌症预后，癌症分期原则，分期/肿瘤/淋巴结/转移（TNM）分类
文献类型Journal Article, Review
ISSN0007-9235
页码516-523
期号73(5)
作者Lauren M Janczewski, Joseph Faski, Heidi Nelson, Marc J Gollub, Cathy Eng, James D Brierley, Joel M Palefsky, Richard M Goldberg, M Kay Washington, Elliot A Asare, Karyn A Goodman

一句话小结 ​

美国癌症联合委员会（AJCC）更新了肛门癌的分期系统，主要通过分析前瞻性数据验证了第9版分期的调整，发现III期A肛门癌的预后优于II期B，表明肿瘤类别对生存影响更大。此研究不仅优化了分期标准，反映了当代肛门癌患者的长期生存结果，也为临床治疗提供了重要依据。

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美国癌症联合委员会（AJCC）第9版 · 肛门癌 · 癌症预后 · 癌症分期原则 · 分期/肿瘤/淋巴结/转移（TNM）分类

摘要 ​

美国癌症联合委员会（AJCC）针对所有癌症部位的分期系统，包括肛门癌，是美国癌症分期的标准。AJCC的分期标准是动态的，定期进行更新，以通过专家小组评估新证据来优化AJCC分期定义，从而实施变更。随着大数据集的可用性增加，AJCC重新构建并更新了其流程，纳入前瞻性收集的数据，以验证第9版AJCC分期系统中肛门癌的阶段组修订。根据AJCC第八版分期指南进行的生存分析显示，III期A肛门癌的预后优于II期B疾病，这表明在肛门癌中，肿瘤（T）类别对生存的影响大于淋巴结（N）类别。因此，第9版阶段组已适当调整，以反映当代的长期结果。本文重点介绍了现已发布的AJCC肛门癌分期系统的变化，包括：（1）将II期B重新定义为T1-T2N1M0疾病，（2）将III期A重新定义为T3N0-N1M0疾病，以及（3）完全从其指南中删除了0期疾病。

英文摘要 ​

The American Joint Committee on Cancer (AJCC) staging system for all cancer sites, including anal cancer, is the standard for cancer staging in the United States. The AJCC staging criteria are dynamic, and periodic updates are conducted to optimize AJCC staging definitions through a panel of experts charged with evaluating new evidence to implement changes. With greater availability of large data sets, the AJCC has since restructured and updated its processes, incorporating prospectively collected data to validate stage group revisions in the version 9 AJCC staging system, including anal cancer. Survival analysis using AJCC eighth edition staging guidelines revealed a lack of hierarchical order in which stage IIIA anal cancer was associated with a better prognosis than stage IIB disease, suggesting that, for anal cancer, tumor (T) category has a greater effect on survival than lymph node (N) category. Accordingly, version 9 stage groups have been appropriately adjusted to reflect contemporary long-term outcomes. This article highlights the changes to the now published AJCC staging system for anal cancer, which: (1) redefined stage IIB as T1-T2N1M0 disease, (2) redefined stage IIIA as T3N0-N1M0 disease, and (3) eliminated stage 0 disease from its guidelines altogether.

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主要研究问题 ​

  1. 在版本9的AJCC分期系统中，如何评估肿瘤(T)类别与淋巴结(N)类别对生存结果的相对影响？
  2. 版本9的AJCC分期系统是如何利用新证据和大数据集来优化肛门癌的分期定义的？
  3. 针对肛门癌的AJCC分期系统更新，是否有新的临床试验或研究支持这些生存结果的变化？
  4. 在重新定义阶段IIB和阶段IIIA时，AJCC是否考虑了患者的其他临床特征或生物标志物？
  5. 除了肛门癌，AJCC的分期系统在其他癌症类型中是否也有类似的动态更新和生存结果分析？

核心洞察 ​

1. 研究背景和目的 ​

美国癌症联合委员会（AJCC）是美国癌症分期的标准制定机构，其针对各类癌症（包括肛门癌）的分期系统具有重要的临床和研究意义。随着新的证据和大数据集的可用性，AJCC对分期系统进行了动态更新，以确保其分期标准反映最新的临床实践和预后数据。本研究的目的是通过生存分析和专家评估，优化肛门癌的分期定义，确保其准确性和有效性，从而改善患者的预后评估。

2. 主要方法和发现 ​

研究利用了AJCC第八版分期指南进行生存分析，发现肛门癌中，III期A（IIIA）和II期B（IIB）之间的预后关系存在不合理之处，III期A的预后竟优于II期B。这一发现表明，肿瘤的（T）类别对生存率的影响大于淋巴结（N）类别。基于这些分析，AJCC对第九版肛门癌的分期系统进行了适当的调整，包括：将IIB期重新定义为T1-T2N1M0病、将IIIA期重新定义为T3N0-N1M0病，并完全删除了0期疾病的分期。

3. 核心结论 ​

AJCC第九版肛门癌分期系统的修订是基于对生存数据的深入分析，强调了肿瘤分期中T类别的重要性。这些修改不仅提高了分期系统的科学性和临床适用性，还解决了之前版本中存在的不合理预后关系，确保了患者预后评估的准确性。

4. 研究意义和影响 ​

此次研究对于肛门癌的临床管理具有重要的影响。通过重新定义分期标准，医生能够更准确地评估患者的预后，进而制定更为个性化的治疗方案。此外，这项研究展示了利用大数据和生存分析方法在癌症分期中的潜力，推动了肿瘤学领域标准化工作的进展。更新后的分期系统将有助于提高肛门癌患者的生存率和生活质量，同时为未来的癌症研究奠定了基础，促进了对肛门癌生物学与治疗策略的进一步探讨。

引用本文的文献 ​

  1. The accuracy of anal self- and companion exams among sexual minority men and transgender women: a prospective analysis. - Alan G Nyitray;Timothy L McAuliffe;Cameron Liebert;Michael D Swartz;Ashish A Deshmukh;Elizabeth Y Chiao;Lou Weaver;Ellen Almirol;Jared Kerman;John A Schneider;J Michael Wilkerson;Lu-Yu Hwang;Derek Smith;Aniruddha Hazra; - Lancet regional health. Americas (2024)
  2. Prognostic evaluation of a multi-target magnetic bead-enriched circulating tumor cell-enriched identification system for colorectal cancer. - Yanfu Wang;Lu Xia;Mei Wu;Chunjin Huang - Journal of gastrointestinal oncology (2024)
  3. Prognostic Significance of Bulky Nodal Disease in Anal Cancer Management: A Multi-institutional Study. - Seok-Joo Chun;Eunji Kim;Won Il Jang;Mi-Sook Kim;Hyun-Cheol Kang;Byoung Hyuck Kim;Eui Kyu Chie - Cancer research and treatment (2024)
  4. Updates on the Version 9 American Joint Committee on Cancer Staging System for Anal Cancer. - Lauren M Janczewski;Elliot A Asare;Karyn A Goodman - Annals of surgical oncology (2024)
  5. Comparison of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma treated nonsurgically and proposal of a new stage grouping system. - Aihong Zheng;Yiwen Wang;Shuang Li;Yingjie Wang;Hong'en Xu;Jieni Ding;Bingchen Chen;Tao Song;Lei Lai - Cancer medicine (2024)
  6. Pre-treatment magnetic resonance imaging in anal cancer: large-scale evaluation of mrT, mrN and novel staging parameters. - Hema Sekhar;Rohit Kochhar;Bernadette Carrington;Thomas Kaye;Damian Tolan;Lee Malcomson;Mark P Saunders;Matthew Sperrin;David Sebag-Montefiore;Marcel van Herk;Andrew G Renehan - British journal of cancer (2024)
  7. Carboplatin and Paclitaxel Chemoradiation for Localized Anal Cancer in Patients Not Eligible for Mitomycin and 5-Fluorouracil. - Alyssa K DeZeeuw;Michael F Bassetti;Evie H Carchman;Charles P Heise;Dana Hayden;Elise H Lawson;Cristina B Sanger;Ray King;Noelle K LoConte;Sam J Lubner;Jeremy D Kratz;Dustin A Deming - Cancers (2024)
  8. Concerning "Updates on the Version 9 American Joint Committee on Cancer Staging System for Anal Cancer": Is the Anal Physical Examination Underestimated? - Roberto Zinicola;Lorenzo Viani;Matteo Rossini;Federico Cozzani - Annals of surgical oncology (2025)
  9. Comparative evaluation of TNM staging systems (eighth vs. ninth edition) for the non-surgical treatment of localized and locally advanced anal squamous cell carcinoma: Prognostic significance of T classification and lymph node status. - Aihong Zheng;Hong'en Xu;Yiming Tao;Bingchen Chen;Jieni Ding;Tao Song;Yanwei Lu - PloS one (2025)
  10. Metastatic Status and Dissection Effect of Regional/Extraregional Lymph Nodes in Japanese Patients with Squamous Cell Carcinoma of the Anal Canal: A Multicenter Retrospective Cohort Study. - Takayuki Torigoe;Keiji Hirata;Kazutaka Yamada;Yoichi Ajioka;Kenichi Sugihara - Journal of the anus, rectum and colon (2025)

... (3 更多 篇文献)

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