Background

Tumor size is still considered a useful prognostic factor in currently available tumor-node-metastasis (TNM) classification staging systems for most solid tumors, but the significance of tumor size on the prognosis of ampullary carcinoma remains controversial. The aim of the current study was to propose a new T-stage classification system for ampullary carcinoma to address the impact of tumor size on the prognostic outcome.

Methods

Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 1080 patients with ampullary carcinoma who underwent radical surgical resection between 2004 and 2015. Based on the results obtained from analysis of various clinicopathologic factors, a new T-stage classification system was proposed.

Results

Among the 1080 patients, 618 were men and 462 were women, with a median tumor size of 2.3 (range 0.1–12) cm. Using the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual, we noticed significant differences in overall survival (OS) between T2 vs. T3 tumors (P < 0.001) and T3 vs. T4 tumors (P = 0.002), but failed to observe significant differences between T1 vs. T2 tumors (P = 0.498) in our pair-wise comparison. Using the newly developed T-stage classification system, we were able to differentiate significant differences in OS between T1 vs. T2 tumors (P = 0.032), T2 vs. T3 tumors (P < 0.001) and T3 vs. T4 tumor (P = 0.003) in all pair-wise comparisons. The c-index of the new staging system was 0.653 (95% CI: 0.629–0.677), showing a better discriminatory power than the 0.636 of the 7th AJCC staging system (95% CI: 0.612–0.660).

Conclusions

The new T-stage classification system described herein can better differentiate prognostic outcomes after radical resection in patients with ampullary carcinoma by incorporating tumor size and depth of tumor infiltration.

中文翻译：

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基于监测、流行病学和最终结果 (SEER) 数据库的壶腹癌 T 分期新分类系统的建议

背景

在目前可用的大多数实体瘤的肿瘤-淋巴结-转移 (TNM) 分期系统中，肿瘤大小仍被认为是一个有用的预后因素，但肿瘤大小对壶腹癌预后的意义仍存在争议。本研究的目的是提出一种新的壶腹癌 T 期分类系统，以解决肿瘤大小对预后结果的影响。

方法

使用监测、流行病学和最终结果 (SEER) 数据库，我们确定了 2004 年至 2015 年间接受根治性手术切除的 1080 名壶腹癌患者。基于对各种临床病理因素的分析结果，一种新的 T 分期分类系统被提议。

结果

在 1080 名患者中，男性 618 人，女性 462 人，中位肿瘤大小为 2.3（范围 0.1-12）cm。使用第 7 版美国癌症联合委员会 (AJCC) 分期手册，我们注意到 T2 与 T3 肿瘤 ( P < 0.001) 和 T3 与 T4 肿瘤 ( P  = 0.002) 之间的总生存期 (OS) 存在显着差异，但 在我们的成对比较中未能观察到 T1 与 T2 肿瘤之间的显着差异（P = 0.498）。使用新开发的 T 期分类系统，我们能够区分 T1 与 T2 肿瘤（P  = 0.032）、T2 与 T3 肿瘤（P < 0.001）和 T3 与 T4 肿瘤（P = 0.003) 在所有成对比较中。新分期系统的c-index为0.653（95% CI：0.629-0.677），比AJCC第7期系统的0.636（95% CI：0.612-0.660）具有更好的判别力。

结论

本文描述的新 T 期分类系统可以通过结合肿瘤大小和肿瘤浸润深度来更好地区分壶腹癌患者根治性切除后的预后结果。