The New American Joint Committee on Cancer T staging system for stomach: increased complexity without clear improvement in predictive accuracy for endoscopic ultrasound

Abstract

Background The efficacy of endoscopic ultrasound (EUS) for determining the T category of gastric cancer is variable. The aim of this study was to evaluate the superiority of EUS by using the 6th edition American Joint Committee on Cancer (AJCC) staging system for stomach cancer compared to the new 7th/8th edition. Methods A retrospective analysis of clinical and EUS imaging features of 348 gastric carcinoma patients who underwent radical resection were retrospectively analyzed. Differences between the 6th and 7th/8th edition T staging systems for preoperative EUS evaluation were compared. Results The accuracy of EUS T staging was 72.4% for the 7th/8th edition and 78.4% for the 6th edition. T3 stage accuracy was significantly worse when the T3 group status was changed. The tumor location, echoendoscope type, and histological type were associated with inaccuracy. We further analyzed the EUS image features for each tumor T stage and found that an indistinctly visible muscularis propria (MP) or with obvious thickening was considered an indicator of lesions involved in the MP with a sensitivity of 81.3%; an MP completely disappeared and accompanied with a serosal layer intact may be a marker that the lesion invaded to the subserosa. We also found that irregularities in the outer edge of the gastric wall were markers of gastric serosal layer penetration with a positive predictive value of 92.2%. Conclusions The increased complexity of the 7th/8th edition T staging system is accompanied by worsening of the predictive accuracy for EUS as compared to the 6th edition. Furthermore, the tumor location, echoendoscope type, histological type, and EUS image features for each tumor T stage should warrant attention.

Risk of lymph node metastasis in early gastric cancer for a Western population

“…Lastly, the role of EUS staging in the decision‐making for ER was not explored as it was only performed in 17% (15/86, 95% CI 11%–27%) of patients. Recent literature has quoted 72% accuracy 44 and 82% sensitivity 45 in EUS T and N staging, respectively; therefore, more frequent use of EUS as a guide for ER decision‐making is likely valuable.…”

Phosphoserine phosphatase as a prognostic biomarker in patients with gastric cancer and its potential association with immune cells

“…The formalin-fixed paraffin-embedded (FFPE) human gastric cancer tissues for routine pathological diagnosis and immunohistochemical analysis were collected from the Department of Pathology, Sun Yat-sen University Cancer Center (SYSUCC) from January 2014 to December 2016. The disease stage of all patients was classified according to the 8th edition of AJCC staging system [ 14 ]. The clinicopathological characteristics of 234 patients with gastric cancer are listed in Table 1 .…”

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

“…Still, it had no benefits in prognostic performance over the pTNM [ 86 ]. However, the current edition doesn't improve the predictive accuracy of endoscopic ultrasound [ 87 ].…”