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
Abstract Objective To compare the survival discrimination of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma (ASCC) treated nonsurgically and suggest a simple revised staging system with data from the Surveillance, Epidemiology, and End Results (SEER) data...
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| Format: | Article |
| Language: | English |
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Wiley
2024-08-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.70119 |
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| author | Aihong Zheng Yiwen Wang Shuang Li Yingjie Wang Hong'en Xu Jieni Ding Bingchen Chen Tao Song Lei Lai |
| author_facet | Aihong Zheng Yiwen Wang Shuang Li Yingjie Wang Hong'en Xu Jieni Ding Bingchen Chen Tao Song Lei Lai |
| author_sort | Aihong Zheng |
| collection | DOAJ |
| description | Abstract Objective To compare the survival discrimination of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma (ASCC) treated nonsurgically and suggest a simple revised staging system with data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods Overall survival (OS) was the primary endpoint. Survival comparisons between the T and N stages and the different staging systems were performed using the Kaplan–Meier method and log‐rank test, followed by correlation analysis and variable importance analysis (VIA). Additionally, multivariate analysis was employed to identify significant predictors, which were further visualized using a nomogram. Finally, calibration curve, C‐index, and decision curve analysis (DCA) were applied to assess the performance of the different staging systems. Results A total of 5384 patients with ASCC were analyzed, revealing superior discrimination OS by the TNM9th edition compared to that by the TNM8th edition. Multivariate analysis identified the T and N stages as significant OS predictors (all p < 0.001). However, ambiguity persisted in stage III subgroups within the TNM9th edition, showing OS times of 102 months for stage IIIA disease, 88 months for stage IIIB disease, and 128 months for stage IIIC disease (all p > 0.05). Correlation analysis demonstrated an increased correlation for the T stage between the TNM8th and 9th editions (ρ value from 0.7 to 0.89), while the N stage correlation decreased (ρ value from 0.84 to 0.56). VIA and the prognostic nomogram highlighted the greater importance of the T stage over the N stage. Based on these findings, a new staging system was developed, and its clinical utility was confirmed through calibration curves, C‐index values (from 0.598 to 0.604), and DCAs. Conclusions Our new staging system exhibited slightly better prognostic value compared to the TNM9th staging systems for nonmetastatic ASCC and warrants further validation. |
| format | Article |
| id | doaj-art-0b62aa29d76d49fc8d6d6ff2d44586d2 |
| institution | Kabale University |
| issn | 2045-7634 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj-art-0b62aa29d76d49fc8d6d6ff2d44586d22024-11-26T10:12:30ZengWileyCancer Medicine2045-76342024-08-011316n/an/a10.1002/cam4.70119Comparison of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma treated nonsurgically and proposal of a new stage grouping systemAihong Zheng0Yiwen Wang1Shuang Li2Yingjie Wang3Hong'en Xu4Jieni Ding5Bingchen Chen6Tao Song7Lei Lai8Cancer Center, Department of Medical Oncology Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College Hangzhou People's Republic of ChinaDepartment of Clinical Medical Engineering The Second Affiliated Hospital, Zhejiang University School of Medicine Hangzhou People's Republic of ChinaCancer Center, Department of Radiation Oncology Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College Hangzhou People's Republic of ChinaDepartment of Oncology Tongxiang First People's Hospital Jiaxing People's Republic of ChinaCancer Center, Department of Radiation Oncology Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College Hangzhou People's Republic of ChinaCancer Center, Department of Radiation Oncology Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College Hangzhou People's Republic of ChinaDepartment of General Surgery, Cancer Center, Division of Colorectal Surgery Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College Hangzhou People's Republic of ChinaCancer Center, Department of Radiation Oncology Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College Hangzhou People's Republic of ChinaDepartment of Oncology Tongxiang First People's Hospital Jiaxing People's Republic of ChinaAbstract Objective To compare the survival discrimination of the TNM9th and 8th editions for localized and locally advanced anal squamous cell carcinoma (ASCC) treated nonsurgically and suggest a simple revised staging system with data from the Surveillance, Epidemiology, and End Results (SEER) database. Methods Overall survival (OS) was the primary endpoint. Survival comparisons between the T and N stages and the different staging systems were performed using the Kaplan–Meier method and log‐rank test, followed by correlation analysis and variable importance analysis (VIA). Additionally, multivariate analysis was employed to identify significant predictors, which were further visualized using a nomogram. Finally, calibration curve, C‐index, and decision curve analysis (DCA) were applied to assess the performance of the different staging systems. Results A total of 5384 patients with ASCC were analyzed, revealing superior discrimination OS by the TNM9th edition compared to that by the TNM8th edition. Multivariate analysis identified the T and N stages as significant OS predictors (all p < 0.001). However, ambiguity persisted in stage III subgroups within the TNM9th edition, showing OS times of 102 months for stage IIIA disease, 88 months for stage IIIB disease, and 128 months for stage IIIC disease (all p > 0.05). Correlation analysis demonstrated an increased correlation for the T stage between the TNM8th and 9th editions (ρ value from 0.7 to 0.89), while the N stage correlation decreased (ρ value from 0.84 to 0.56). VIA and the prognostic nomogram highlighted the greater importance of the T stage over the N stage. Based on these findings, a new staging system was developed, and its clinical utility was confirmed through calibration curves, C‐index values (from 0.598 to 0.604), and DCAs. Conclusions Our new staging system exhibited slightly better prognostic value compared to the TNM9th staging systems for nonmetastatic ASCC and warrants further validation.https://doi.org/10.1002/cam4.70119anal squamous cell carcinomacomparisonoverall survivalTNM |
| spellingShingle | Aihong Zheng Yiwen Wang Shuang Li Yingjie Wang Hong'en Xu Jieni Ding Bingchen Chen Tao Song Lei Lai 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 Cancer Medicine anal squamous cell carcinoma comparison overall survival TNM |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | anal squamous cell carcinoma comparison overall survival TNM |
| url | https://doi.org/10.1002/cam4.70119 |
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