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Survival outcomes used to validate version 9 of the American Joint Committee on Cancer staging system for appendiceal cancer. ​

文献信息 ​

DOI10.3322/caac.21806
PMID37358310
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7
关键词美国癌症联合委员会（AJCC）分期，阑尾癌，粘液性阑尾癌，非粘液性阑尾癌，印戒细胞阑尾癌
文献类型Journal Article, Review, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural
ISSN0007-9235
页码590-596
期号73(6)
作者Lauren M Janczewski, Amanda E Browner, Joseph H Cotler, Heidi Nelson, Sanjay Kakar, Norman J Carr, Nader N Hanna, Andreana N Holowatyj, Richard M Goldberg, M Kay Washington, Elliot A Asare, Michael J Overman

一句话小结 ​

本文探讨了美国癌症联合委员会（AJCC）第九版阑尾癌分期系统的核心改进，强调了通过生存分析对不同组织类型（如非粘液性、粘液性、印戒细胞）进行分组的合理性及其对稀有肿瘤临床挑战的影响。研究结果为阐明分期异质性和数据限制在低级别阑尾粘液性肿瘤生存分析中的作用提供了重要见解，推动了癌症分期标准的现代化进程。

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美国癌症联合委员会（AJCC）分期 · 阑尾癌 · 粘液性阑尾癌 · 非粘液性阑尾癌 · 印戒细胞阑尾癌

摘要 ​

美国所有癌症部位（包括阑尾原发性癌）的癌症分期标准是美国癌症联合委员会（AJCC）分期系统。AJCC分期标准定期进行修订，由特定部位的专家小组主导，以通过评估新证据来保持现代分期定义。自上次修订以来，AJCC已重组其流程，将前瞻性收集的数据纳入其中，因为随着时间的推移，大型数据集变得越来越可靠和可用。因此，使用AJCC第八版分期标准的生存分析被用于通知版本9 AJCC分期系统中的分期组修订，包括阑尾癌。尽管当前AJCC对阑尾癌的分期定义得以维持，但将生存分析纳入版本9分期系统为分期稀有恶性肿瘤的临床挑战提供了独特的见解。本文重点介绍了现已发布的版本9 AJCC阑尾癌分期系统的关键临床组成部分，这些组成部分（1）证明了在预后差异方面将三种不同组织类型（非粘液性、粘液性、印戒细胞）分开的合理性，（2）展示了在分期异质性和稀有肿瘤时的临床影响和挑战，以及（3）强调了数据限制对低级别阑尾粘液性肿瘤生存分析的影响。

英文摘要 ​

The standard for cancer staging in the United States for all cancer sites, including primary carcinomas of the appendix, is the American Joint Committee on Cancer (AJCC) staging system. AJCC staging criteria undergo periodic revisions, led by a panel of site-specific experts, to maintain contemporary staging definitions through the evaluation of new evidence. Since its last revision, the AJCC has restructured its processes to include prospectively collected data because large data sets have become increasingly robust and available over time. Thus survival analyses using AJCC eighth edition staging criteria were used to inform stage group revisions in the version 9 AJCC staging system, including appendiceal cancer. Although the current AJCC staging definitions were maintained for appendiceal cancer, incorporating survival analysis into the version 9 staging system provided unique insight into the clinical challenges in staging rare malignancies. This article highlights the critical clinical components of the now published version 9 AJCC staging system for appendix cancer, which (1) justified the separation of three different histologies (non-mucinous, mucinous, signet-ring cell) in terms of prognostic variance, (2) demonstrated the clinical implications and challenges in staging heterogeneous and rare tumors, and (3) emphasized the influence of data limitations on survival analysis for low-grade appendiceal mucinous neoplasms.

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主要研究问题 ​

  1. 在AJCC第9版分期系统中，如何具体评估不同组织学类型（非粘液性、粘液性、印戒细胞）对生存结果的影响？
  2. 除了生存分析外，还有哪些方法可以用来验证AJCC分期系统在阐明罕见肿瘤临床挑战方面的有效性？
  3. 在进行生存分析时，数据限制如何影响对低级别粘液性阑尾肿瘤的分期及其预后评估？
  4. 未来的AJCC分期系统是否有计划进一步整合新的数据集，以改善对阑尾癌等罕见恶性肿瘤的分期？
  5. 版本9的AJCC分期系统在临床应用中，如何帮助医生更好地管理和治疗不同类型的阑尾癌患者？

核心洞察 ​

研究背景和目的 ​

本研究旨在验证美国癌症联合委员会（AJCC）第9版分期系统在阑尾癌中的应用，特别是针对阑尾癌的生存结果分析。尽管阑尾癌是一种相对罕见的恶性肿瘤，其发病率在过去30年中却显著上升，因此对其分期和预后评估显得尤为重要。AJCC分期系统定期修订，以确保其与最新的临床数据相一致。

主要方法/材料/实验设计 ​

本研究采用以下步骤进行AJCC第9版分期系统的验证：

  1. 数据收集：从国家癌症数据库（NCDB）中收集阑尾癌患者的数据，涉及11799名患者，分析其生存结果。
  2. 生存分析：对不同组织学亚型（非粘液性、粘液性和印戒细胞癌）进行生存分析，评估其在不同分期下的预后差异。
  3. 数据处理：通过AJCC第8版分期系统进行生存分析，以支持第9版分期的修订。
Mermaid diagram

关键结果和发现 ​

  1. 生存率分析：
    • 非粘液性阑尾癌患者的5年生存率依赖于分期，I期为90.34%，而IVC期仅为14.18%。
    • 粘液性阑尾癌患者的5年生存率在I期为92.80%，IVC期为46.81%。
    • 印戒细胞癌患者的生存率较低，I期为86.67%，IV期为12.81%。
  2. 组织学亚型影响：不同组织学亚型之间存在显著的预后差异，特别是在生存率的层级排序上，非粘液性肿瘤未能表现出一致的生存层级。

主要结论/意义/创新性 ​

本研究确认了AJCC第9版分期系统的有效性，强调了不同组织学亚型在预后评估中的重要性。尽管第9版分期系统维持了第8版的基本结构，但通过生存分析提供了对阑尾癌临床挑战的新见解，特别是在处理稀有肿瘤的异质性时。

研究局限性和未来方向 ​

  1. 局限性：
    • 数据收集的局限性导致低级粘液性肿瘤的生存分析未能包含在内。
    • 阑尾癌的罕见性使得前瞻性临床试验难以开展，影响了治疗指导的更新。
  2. 未来方向：
    • 需要进一步的多中心前瞻性研究，以改善对阑尾癌的治疗策略。
    • 加强对低级粘液性肿瘤的研究，优化其分期标准和生存数据的收集。

通过对AJCC第9版分期系统的验证，研究为阑尾癌的临床管理提供了重要依据，未来应继续关注稀有肿瘤的研究与治疗进展。

参考文献 ​

  1. Epithelial noncarcinoid tumors and tumor-like lesions of the appendix. - N J Carr;L H Sobin - Cancer (1995)
  2. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973-1998. - Margaret E McCusker;Timothy R Coté;Limin X Clegg;Leslie H Sobin - Cancer (2002)
  3. The rise in appendiceal cancer incidence: 2000-2009. - Schelomo Marmor;Pamela R Portschy;Todd M Tuttle;Beth A Virnig - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (2015)
  4. Grading and staging mucinous neoplasms of the appendix: a case series and review of the literature. - Sarah E Umetsu;Nafis Shafizadeh;Sanjay Kakar - Human pathology (2017)
  5. Continued increasing incidence of malignant appendiceal tumors in Canada and the United States: A population-based study. - Harminder Singh;Ananda S Koomson;Kathleen M Decker;Jason Park;Alain A Demers - Cancer (2020)
  6. Staging of appendiceal mucinous neoplasms: challenges and recent updates. - Sarah E Umetsu;Sanjay Kakar - Human pathology (2023)
  7. Appendiceal mucinous neoplasms: clinicopathologic study of 116 cases with analysis of factors predicting recurrence. - Reetesh K Pai;Andrew H Beck;Jeffrey A Norton;Teri A Longacre - The American journal of surgical pathology (2009)
  8. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. - Joseph Misdraji;Rhonda K Yantiss;Fiona M Graeme-Cook;Ulysses J Balis;Robert H Young - The American journal of surgical pathology (2003)
  9. Improving the AJCC/TNM staging for adenocarcinomas of the appendix: the prognostic impact of histological grade. - Michael J Overman;Keith Fournier;Chung-Yuan Hu;Cathy Eng;Melissa Taggart;Richard Royal;Paul Mansfield;George J Chang - Annals of surgery (2013)
  10. Adenocarcinoma of the appendix is rarely detected by colonoscopy. - Apurva N Trivedi;Edward A Levine;Girish Mishra - Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (2009)

引用本文的文献 ​

  1. AJCC Cancer Staging System Version 9: Appendiceal Adenocarcinoma. - Nader Hanna;Andrew N Hanna;David N Hanna - Annals of surgical oncology (2024)
  2. Current Status of Treatment among Patients with Appendiceal Tumors-Old Challenges and New Solutions? - Katarzyna Chawrylak;Magdalena Leśniewska;Katarzyna Mielniczek;Katarzyna Sędłak;Zuzanna Pelc;Sebastian Kobiałka;Timothy M Pawlik;Wojciech P Polkowski;Karol Rawicz-Pruszyński - Cancers (2024)
  3. Mucinous neoplasm of the appendix: A case report and review of literature. - Hao-Cheng Chang;Jung-Cheng Kang;Ta-Wei Pu;Ruei-Yu Su;Chao-Yang Chen;Je-Ming Hu - World journal of gastrointestinal surgery (2024)
  4. Analysis of survival and prognostic factors in appendix adenocarcinoma and mucinous carcinoma. - Bilal Turan;Ahmet Necati Sanli;Serdar Acar - Updates in surgery (2025)
  5. Defining a 'cells to society' research framework for appendiceal tumours. - Andreana N Holowatyj;Michael J Overman;Konstantinos I Votanopoulos;Andrew M Lowy;Patrick Wagner;Mary K Washington;Cathy Eng;Wai Chin Foo;Richard M Goldberg;Mojgan Hosseini;Kamran Idrees;Douglas B Johnson;Ardaman Shergill;Erin Ward;Nicholas C Zachos;Deborah Shelton; - Nature reviews. Cancer (2025)
  6. Fusobacterium nucleatum Is Associated with Tumor Characteristics, Immune Microenvironment, and Survival in Appendiceal Cancer. - Christopher Sherry;Neda Dadgar;Hyun Park;Chelsea Knotts;Erin Grayhack;Rose Blodgett;Kunhong Xiao;Ashten N Omstead;Albert D Donnenberg;David L Bartlett;Vera Donnenberg;Ajay Goel;Ali H Zaidi;Patrick L Wagner - Microorganisms (2025)
  7. Prognosis Prediction and Surgical Benefit Subgroup Analysis in Anal Squamous Cell Carcinoma Patients Undergoing Concurrent Chemoradiotherapy. - Quan Wang;Guangmin Wan;Lu Yang;Gang Xu - Cancer medicine (2025)

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