Subclassification of Stage IV Gastric Cancer (IVa, IVb, and IVc) and Prognostic Significance of Substages

Ma, Yan; Xue, Yingwei; Li, Yanfeng; Lan, Xiuwen; Zhang, Yongle; Zhang, Ming

doi:10.1007/s11605-009-1110-5

Cited by 7 publications

(6 citation statements)

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“…An et al 14 Ma et al 15 also predicted that subclassification of stage IV gastric cancer into IVA (T1-2N3M0), IVB (T3N3M0 and T4N1-2M0), and IVC (T4N3M0, TanyNanyM1) may be helpful to predict the outcome for patients with stage IV gastric cancer as classified by the 6th edition system. Additionally, Ahn et al determined that survival for pN3 gastric cancer patients after curative gastrectomy was significantly longer in the pN3/M0 group as compared with that of the pN3/M1 group, and advanced T stage was a predictor of poor prognosis for pN3 patients based on 467 cases of gastric cancer patients classified by the 6th edition system.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the 6th and 7th editions of the UICC TNM staging system for gastric cancer: Results of a Chinese single-institution study of 1,503 patients.

Wang

2011

JCO

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Aim. To evaluate the prognostic efficacy of the 7th edition tumor-node-metastasis (TNM) classification compared with the 6th edition in gastric cancer patients. Methods. A total of 1,503 gastric cancer patients undergoing surgical resection were staged using the 6th and 7th edition staging systems. Homogeneity, discriminatory ability, and monotonicity of gradients of the two systems were compared using linear trend v 2 , likelihood ratio v 2 statistics, and Akaike information criterion (AIC) calculations.Results. Significant differences in 5-year survival rates were observed for the T, N, and M subgroups using the 7th edition system, except for stage N2 and N3 patients in the 6th edition system. There were no significant differences in survival between IB and IIA in the 7th edition system. Patients with stage IV disease due to T4/N3 in the 6th edition system who were downstaged to stage III in the 7th edition system had significantly better survival than those who remained at stage IV. The 7th edition system had higher linear trend and likelihood ratio v 2 scores, and smaller AIC values compared with those for the 6th edition, which represented the optimum prognostic stratification.Conclusions. Our study suggests that the 7th edition system performs better than the 6th edition in several aspects.Gastric cancer is the fourth most common malignant tumor in the world, with an estimated 1 million new cases every year.1 More new cases of gastric cancer are diagnosed in China each year than in any other country.

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Section: Discussionmentioning

confidence: 99%

Comparison of the 6th and 7th editions of the UICC TNM staging system for gastric cancer: Results of a Chinese single-institution study of 1,503 patients.

Wang

2011

JCO

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“…An et al reported each subgroup of stage IV gastric cancer in the 6th edition system to have different clinical outcomes, and thus subclassification of stage IV gastric cancer into IVA (T1-3N3M0), IVB (T4N1-3M0), and IVM (T[any]N[any]M1) might be useful for more accurate prediction of prognosis 14. Ma et al15 also predicted that subclassification of stage IV gastric cancer into IVA (T1-2N3M0), IVB (T3N3M0 and T4N1-2M0), and IVC (T4N3M0, TanyNanyM1) may be helpful to predict the outcome for patients with stage IV gastric cancer as classified by the 6th edition system. Additionally, Ahn et al determined that survival for pN3 gastric cancer patients after curative gastrectomy was significantly longer in the pN3/M0 group as compared with that of the pN3/M1 group, and advanced T stage was a predictor of poor prognosis for pN3 patients based on 467 cases of gastric cancer patients classified by the 6th edition system 16.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the 6th and 7th Editions of the UICC TNM Staging System for Gastric Cancer: Results of a Chinese Single-Institution Study of 1,503 Patients

Wang

Sun

et al. 2010

Ann Surg Oncol

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AimTo evaluate the prognostic efficacy of the 7th edition tumor–node–metastasis (TNM) classification compared with the 6th edition in gastric cancer patients.MethodsA total of 1,503 gastric cancer patients undergoing surgical resection were staged using the 6th and 7th edition staging systems. Homogeneity, discriminatory ability, and monotonicity of gradients of the two systems were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations.ResultsSignificant differences in 5-year survival rates were observed for the T, N, and M subgroups using the 7th edition system, except for stage N2 and N3 patients in the 6th edition system. There were no significant differences in survival between IB and IIA in the 7th edition system. Patients with stage IV disease due to T4/N3 in the 6th edition system who were downstaged to stage III in the 7th edition system had significantly better survival than those who remained at stage IV. The 7th edition system had higher linear trend and likelihood ratio χ2 scores, and smaller AIC values compared with those for the 6th edition, which represented the optimum prognostic stratification.ConclusionsOur study suggests that the 7th edition system performs better than the 6th edition in several aspects.

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“…Second, within the same N category, the 5-year OS rates of pT4a patients were similar to those of pT4b patients. In some previous studies, the OS rates of pT4a and pT4b patients were significantly different [21,38]. However, those analyses were not based on the same pN category.…”

Section: Discussionmentioning

confidence: 86%

Multicenter Validation Study of the American Joint Commission on Cancer (8th Edition) for Gastric Cancer: Proposal for a Simplified and Improved TNM Staging System

Lin¹,

Desiderio²,

Lin³

et al. 2020

J. Cancer

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Objective: To evaluate the prognostic significance of the eighth edition of the American Joint Committee on Cancer (AJCC) TNM staging classification for gastric cancer. Methods: Prospective databases were reviewed to identify patients who underwent radical gastrectomy at two specialized eastern centers. The prognostic value of the eighth edition TNM classification was estimated and compared with that of the seventh edition. Additional external validation was performed using a dataset from a Western population. Results: Significant differences in 5-year overall survival (OS) rates were observed for each TNM stage when using the eighth edition system, and smaller Akaike information criteria (AIC) values and a higher c-statistic were observed relative to those of the seventh edition. However, the OS rates in each subgroup of stage III patients based on the eighth edition were significantly different. Patients with the same pN stage, namely, the pT4a and pT4b groups, showed similar 5-year OS (P>0.05). Based on the survival data, we propose a simplified staging system. In the improved TNM (iTNM) staging system, the subgroups of a given TNM stage do not show statistically significant differences in OS. The iTNM staging exhibits superior prognostic stratification, with lower AIC values and a higher c-statistic than the eighth edition TNM classification. Similar results were obtained with the external validation dataset from the IMIGASTRIC database. Conclusion: The prognostic prediction of the eighth edition of the AJCC TNM classification is superior to that of the seventh edition. However, it remains associated with some stage migration. The iTNM staging system permits simplification and slightly better prognostic prediction.

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Subclassification of Stage IV Gastric Cancer (IVa, IVb, and IVc) and Prognostic Significance of Substages

Abstract: Subclassification of stage IV gastric cancer into IVa (T1-2N3M0), IVb (T3N3M0 and T4N1-2M0), and IVc (T4N3M0, TanyNanyM1) may be helpful to predict the outcome and determine the therapeutic strategies for patients with stage IV gastric cancer.

Cited by 7 publications

References 20 publications

Comparison of the 6th and 7th editions of the UICC TNM staging system for gastric cancer: Results of a Chinese single-institution study of 1,503 patients.

Comparison of the 6th and 7th editions of the UICC TNM staging system for gastric cancer: Results of a Chinese single-institution study of 1,503 patients.

Comparison of the 6th and 7th Editions of the UICC TNM Staging System for Gastric Cancer: Results of a Chinese Single-Institution Study of 1,503 Patients

Multicenter Validation Study of the American Joint Commission on Cancer (8th Edition) for Gastric Cancer: Proposal for a Simplified and Improved TNM Staging System

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