Revisiting the 8th AJCC system for gastric cancer: A review on validations, nomograms, lymph nodes impact, and proposed modifications

Mranda, Geofrey Mahiki; Xiang, Zhi-Ping; Zhou, Xingguo; Liu, Junjian; Xue, Ying; Wang, Yu; Wei, Tian; Ding, Youming

doi:10.1016/j.amsu.2022.103411

Cited by 23 publications

(15 citation statements)

References 85 publications

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“…The exact number of lymph nodes to be examined is one of the key issues in gastric cancer surgery. The 8th American Joint Committee on Cancer (AJCC) staging guideline has recommended a minimal requirement of 16 lymph nodes for improved lymph node staging, and 30 or more lymph nodes for accurate staging and prognosis prediction [ 14 , 26 ]. However, such investigation targeting GSRCC is rarely established.…”

Section: Discussionmentioning

confidence: 99%

“…A Korean Central Cancer Registry survey reports that regional lymph node metastasis of GSRCC occurred very less in mucosal stage of less than 3.9% patients, but with increased risk of poor outcome [ 11 ]. Standardized therapeutic management indicates that an extended D2 lymphadenectomy is necessary with at least 16 lymph nodes to be examined for adequate staging [ 12 , 13 , 14 ]. In a nation-level study in France with 899 GSRCC cases, a standard D2 or modified D2 lymphadenectomy was preferred [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Zhou

Liu

et al. 2022

Diagnostics

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Background: Gastric signet ring cell carcinoma (GSRCC) is a subset of gastric cancer with distinct histological and inconsistent prognosis outcome. Currently, the association between the adequate regional lymph node and proper nodal staging in GSRCC is rarely noticed. Materials and methods: Clinical data of GSRCC were retrieved from the Surveillance, Epidemiology, and End Results database. Beta-binomial distribution model was employed for the estimation of the probability of missing nodal disease, followed by the development of a nodal staging score (NSS). Results: A total of 561 GSRCC patients were included in this study, with 193 in lymph node-negative and 368 in lymph node-positive diagnoses. As the number of examined lymph nodes increased, the probability of missing nodal disease decreased rapidly, with T stage-specific curves. The probability of missing nodal disease in T4 was lower than that in T1. NSS calculation indicated that T1 stage patients commonly had NSS > 0.8. However, with the NSS of T2-T4 to reach 0.8, the number of examined lymph node was required to be larger than 12 in T2, 17 in T3 and 27 in T4. NSS ≥ 0.75 (quantile 75%) subgroup in T2–T4 subgroups tended to have better outcome; however, without significant prognostic value. Conclusion: NSS is served as a reliable and feasible tool in adequate nodal staging of GSRCC with statistical basis and provides further evidence for clinical decision making.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Zhou

Liu

et al. 2022

Diagnostics

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“…Electronic medical records of consecutive patients with GC who underwent curative-intent surgical resection at Kyung Hee University Hospital at Gangdong from June 2006 to October 2017 were reviewed. The inclusion criteria were as follows: Stage I to III GC; [32] No preoperative anticancer treatment; and Microscopically margin-negative resection (i.e., resection). The exclusion criteria were as follows: Concurrent malignancies, or prior malignancies within the last 5 years; Microscopic or macroscopic residual tumor; and Autoimmune diseases or active infection.…”

Section: Patientsmentioning

confidence: 99%

Monocyte-to-lymphocyte ratio as a determinant of survival in patients with gastric cancer undergoing gastrectomy: A cohort study

Lee

et al. 2023

Medicine

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The monocyte-to-lymphocyte ratio (MLR) is an important prognostic determinant of various malignancies. However, the prognostic role of MLR in patients with gastric cancer undergoing gastrectomy remains unclear. Patients with stage I to III gastric cancer who underwent curative-intent gastric resection were enrolled in this study. Cox regression analysis was used to determine the independent variables for overall survival (OS) and disease-free survival (DFS). The established models were validated internally. Inter-model comparisons were performed using the integrated area under the receiver operating characteristic curve and the concordance index. Multivariate Cox regression analysis revealed that age, tumor-node-metastasis (TNM) stage, perineural invasion, serum albumin level, and MLR were prognostic factors for OS and DFS and constituted the full model. The full model was internally validated using calibration curves and decision curve analysis. The integrated area under the curve and concordance index of the full model outperformed those of TNM stage. The full model was a significant determinant of OS and DFS. Additionally, the full model was suggested to outperform TNM stage in predicting patient survival outcomes.Abbreviations: ALB = serum albumin level, ALC = absolute lymphocyte count, AMC = absolute monocyte count, AUC = area under the curve, C-index = concordance index, DCA = decision curve analysis, DFS = disease-free survival, GC = gastric cancer, HR = hazard ratio, iAUC = integrated AUC, MLR = monocyte-to-lymphocyte ratio, NLR = neutrophil-to-lymphocyte ratio, OS = overall survival, PLR = platelet-to-lymphocyte ratio, PNI = perineural invasion, ROC = receiver operating characteristic, TNM = tumor-node-metastasis, VIF = variance inflation factor.

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“…who underwent curative-intent gastrectomy at Kyung Hee University Hospital at Gangdong between June 2006 and December 2017 were analyzed. The inclusion criteria were as follows: (i) primary GC, (ii) stage I-III GC according to the American Joint Committee on Cancer staging system (8th edition) [16], and (iii) negative resection margins. The exclusion criteria included: (i) concurrent malignancies or malignancies within the past 5 years, (ii) administration of any anticancer treatment prior to surgery, (iii) development of severe infections within 4 weeks before gastrectomy, and (iv) pre-existing active infection or autoimmune diseases.…”

Section: Patientsmentioning

confidence: 99%

Comparison of the Clinical Value of the Geriatric Nutritional Risk Index and Prognostic Nutritional Index as Determinants of Survival Outcome in Patients with Gastric Cancer

An¹,

Eo²,

Lee³

2022

J. Cancer

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Background:The geriatric nutritional risk index (GNRI) is an important determinant of overall survival (OS) in patients with stage I-III gastric cancer (GC) across all ages; however, its value as a determinant of disease-free survival (DFS) is unclear. Moreover, the prognostic values between the GNRI and prognostic nutritional index (PNI) remains unclear. Methods: We retrospectively evaluated the value of the GNRI and PNI as determinants of OS and DFS in patients with stage I-III GC who underwent curative-intent gastrectomy. Cox regression analysis was used for evaluating the determinants of survival outcomes. The discriminative capacity of the prognostic model was determined using the concordance index (C-index), and then C-indices of related models were compared. Results: Data from 450 patients were analyzed. The median patient age was 60 years (range: 26-92 years). In total, 276 (61.3%) patients had stage I cancer, 83 (18.4%) had stage II cancer, and 91 (20.2%) had stage III cancer. Multivariate Cox regression analysis revealed that age, type of gastrectomy (TOG), T stage, tumor-node-metastasis (TNM) stage, and GNRI were determinants of OS. These five covariates constituted the GNRI model for the OS. In addition, multivariate analysis revealed that age, TOG, TNM stage, and GNRI were determinants of DFS. These four covariates constituted the GNRI model for DFS. When constructing the PNI model for OS (comprising age, TOG, T stage, TNM stage, and PNI), and PNI model for DFS (including age, TOG, TNM stage, and PNI), the C-indices of the GNRI and PNI models were nearly equal for OS (0.818 and 0.818, respectively; p=0.909) and DFS (0.805 and 0.808, respectively; p=0.653). Using the GNRI models, nomograms for predicting OS and DFS were established. When validating the nomograms using calibration curves, the predicted survival closely matched the actual survival rate. Conclusion:The GNRI and PNI were important determinants of both OS and DFS in patients with GC across all ages. In addition, the effects of the GNRI model on OS and DFS were similar to those of the PNI model.

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Revisiting the 8th AJCC system for gastric cancer: A review on validations, nomograms, lymph nodes impact, and proposed modifications

Cited by 23 publications

References 85 publications

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Pathological Nodal Staging Score for Gastric Signet Ring Cell Carcinoma: A Clinical Tool of Adequate Nodal Staging

Monocyte-to-lymphocyte ratio as a determinant of survival in patients with gastric cancer undergoing gastrectomy: A cohort study

Comparison of the Clinical Value of the Geriatric Nutritional Risk Index and Prognostic Nutritional Index as Determinants of Survival Outcome in Patients with Gastric Cancer

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