美國癌症聯合委員會分期系統有效性評估：第7版和第8版比較分析

Abstract

背景及目的 美國癌症聯合委員會（AJCC）的分期手冊在全球被廣泛認可且經過定期的修訂。本研究旨在評估比較AJCC第8版與第7版在台灣癌症分類上的表現。 方法 本研究利用台灣癌症登記資料，納入2017年（AJCC第7版）和2018年（AJCC第8版）診斷的癌症病例，進行2年的追蹤。使用ROC （receiver operating characteristic）曲線下面積（area under the curve, AUC）和基於Lorenz曲線的Gini係數進行評估。 結果 在研究的20個癌症部位/亞型中，根據 ∆ AUC或 ∆ Gini，我們發現口咽癌、肝癌、非小細胞肺癌、前列腺癌在AJCC第8版的分期表現上有顯著的改善。在口咽癌的患者中，第1期患者的兩年存活率增加，而4A和4C期患者的兩年存活率下降。肝癌的兩年存活率在第8版中隨著癌症期別越高而降低，但在第7版中，3B期患者的存活率（15.7％）甚至低於3C期（28.7％）和4A期（16.2％）。第8版在非小細胞肺癌上實現了更精細的預後分期，分離出1A1、1A2和1A3期，並辨別出較沒那麼嚴重的4A期患者。前列腺癌在第7版中有26.4％的4期患者可以重新分類為第8版的3期或4A期，分離出來的患者的存活率都超過90％。 結論 我們的研究結果發現AJCC分期系統第8版的修訂對台灣的口咽癌、肝癌、非小細胞肺癌和前列腺癌存活曲線的分離產生了正面的影響。

Background: The American Joint Committee on Cancer (AJCC) staging manual is globally recognized and regularly revised. This study aims to evaluate the effectiveness of the AJCC 8th edition compared to the 7th edition in Taiwan. Methods: Data from the Taiwan Cancer Registry were utilized for this study. Cancer cases diagnosed in 2017 (AJCC 7th edition) and 2018 (AJCC 8th edition) were included, and follow-up for 2 years. The performance was assessed using the area under the receiver operating characteristic curve (AUC) and the Lorenz curve-based Gini index. Results: Among the 20 cancer sites/subtypes studied, 4 cancers (described below) showed significantly improved performance in the 8th edition, as indicated by ∆AUC or ∆Gini. For the 2-year survival rates of oropharyngeal cancer, the rate increased for stage 1 patients and decreased for stage 4A and 4C patients. The survival rates for liver cancer decreased with advanced stages in the 8th edition, but in the 7th edition, the rate in 3B (15.7%) was even lower than those in 3C (28.7%) and 4A (16.2%). For non-small cell lung cancer, the split-out stages 1A1, 1A2, and 1A3 had achieved a more refined prognostic staging in the 8th edition, and the split-out stage 4A had identified a group of patients with a less dire prognosis. For prostate cancer, 26.4% of 7th‘s stage 4 patients could be reclassified as 8th’s stage 3 or stage 4A, with a survival rate exceeding 90%. Conclusions: Our study findings demonstrate that the revisions in the 8th edition of the AJCC staging system had a positive effect on the separation of survival curves for oropharyngeal, liver, non-small cell lung, and prostate cancer in Taiwan.