Validation of the American Joint Committee on Cancer (AJCC) 8th edition stage system for gastric cancer patients: a population-based analysis

He, Xingkang; Wu, Wenrui; Lin, Zhenghua; Ding, Yuanyuan; Si, Jianmin; Sun, Limei

doi:10.1007/s10120-017-0770-1

Cited by 49 publications

(33 citation statements)

References 41 publications

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“…According to the eighth edition of the American Joint Committee on Cancer (AJCC) tumor-lymph node-metastasis (TNM) classification, stage I GC has two subtypes: stage IA (invading the mucosa and submucosa, no positive lymph nodes, and no distant metastasis, T1N0M0) and stage IB. The stage IB GC consists of T1N1M0 (invading the mucosa and submucosa, having one to two positive lymph nodes but no distant metastasis) and T2N0M0 (invading the muscularis propria, no positive lymph nodes, and no distant metastasis) [ 2 , 3 ]. Patients with stage I GC typically have an excellent prognosis but there is still a small risk of relapses or distant metastases.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors in stage I gastric cancer: A retrospective analysis

et al. 2020

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PurposeThe purpose of this research is to investigate the prognostic factors of patients with stage I gastric cancer (GC) and to determine whether adjuvant chemotherapy improves the prognosis for high-risk patients.MethodsWe performed a retrospective analysis at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, and HwaMei Hospital, University of Chinese Academy of Sciences from January 2001 to December 2015. Cox regression and Kaplan-Meier were used to evaluate the relationship between the patients’ clinicopathologic characteristics and prognosis.ResultsA total of 1,550 patients were eligible for the study. The 5-year disease-free survival (DFS) rate of all enrolled patients was 96.5%. The pT and pN stages were significantly associated with the prognosis. The 5-year DFS rates of the three subgroups (T1N0, T2N0, and T1N1) were 97.8%, 95.7%, and 90.5%, respectively (p < 0.001). In the T1N1 subgroup, patients not undergoing chemotherapy showed a lower 5-year DFS rate compared to those undergoing chemotherapy, although the difference was not statistically significant.ConclusionsBoth the pT and pN stages were closely associated with the prognosis of patients with stage I GC. We also found that the danger coefficient of the pN stage was higher than that of the pT stage, and that postoperative adjuvant chemotherapy might be a reasonable approach to improve outcomes of high-risk patients, particularly in the T1N1 group.

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Section: Introductionmentioning

confidence: 99%

Prognostic factors in stage I gastric cancer: A retrospective analysis

et al. 2020

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“…Those metastases are an independent factor for poor prognosis, reducing patient disease-free survival and overall survival. The detection of LN metastases is critical for the correct classification of tumoral staging and should be investigated, to allow the best prognostic definition of CG, and to provide the means for the stratification of individuals who could benefit or not from adjuvant chemotherapy 1,5,12 . The frequency of micrometastases in GC is estimated between 10% to 30%.…”

Section: Discussionmentioning

confidence: 99%

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma – Case series

Santos

Drummond-Lage

Wainstein

et al. 2020

Sci Rep

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Gastric carcinoma (GC) locoregional recurrence may occur even in cases where the tumor has been completely resected, possibly due to lymph node (LN) micrometastases. It is estimated that in 10% to 30% of cases, LN micrometastases are not detected by a conventional method for histological assessment of LN metastases with hematoxylin-eosin (HE). A cross-sectional study assessed 51 patients with GC by histological evaluation of the LN micrometastases through LN multi sectioning associated with immunohistochemistry analysis with monoclonal antibodies AE1 and AE3. Total gastrectomy was performed in 51% of patients. The total number of resected LN nodes was 1698, with a mean number of resected LN of 33.3 ± 13.2 per surgical specimen, of which 187 had metastasis. After the application of LN multisection and immunohistochemistry, LN micrometastases were found in 45.1% of the cases. LN staging changed in 29.4%, and tumor staging changed in 23.5% of the cases. In patients initially staged as pN0, LN staging and tumor staging changed, both in 19.2% of the cases. In patients initially staged as pN1 or more, LN staging changed in 40.0% of them, and tumor staging changed in 28.0% of the cases. The accuracy of HE for the histological staging of LN tumoral involvement was 76%, which was considered insufficient for CG patients staging. Investigation of LN micrometastasis through LN multisection and immunohistochemistry should be performed, particularly in cases where the presence of blood and lymphatic vessel invasion has been identified after conventional histological analysis, as well as in patients with advanced Gc. Gastric carcinoma (GC), despite the recent decrease observed in its incidence, remains the second most common cause of cancer death in the world, with more than 600,000 deaths per year. The main chance of cure of this neoplasm is on surgical resection. The standard procedure for the treatment of this condition is radical gastrectomy, which includes gastric resection with surgical margins free of neoplasia, associated with extended locoregional lymphadenectomy 1-3. Accurate tumor staging is one of the leading factors in the definition of the therapeutic strategy. From the exact knowledge of the extent of tumor dissemination, it is possible to define, with greater security, the best therapeutic approach for each patient, and, consequently, avoid incomplete or excessive treatments 4,5. Recent literature has discussed the role of lymph node (LN) micrometastasis in GC. Conceptually, micrometastases are metastases of sizes between 0.2 mm and 2.0 mm (5). Its incidence varies between 10% to 30% 6,7. Currently, many authors admit that its presence is associated with a worse prognosis and that the clinical behavior of these patients is like those with lymph node involvement by metastasis 8. In the submucosal GC (T1b), with the absence of LN metastases and micrometastases, the five-year survival rate is close to 100%, being significantly higher than in micrometastases positive cases (82%) 6. The presence of micrometastasis ma...

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“…Information on pathological variables, including tumor location, differentiation, perineural invasion, lymph vascular invasion, and tumor size, were obtained from the histopathological reports. T and N stages were classi ed according to the 8th edition of the (Union for International Cancer Control/American Joint Committee on Cancer) UICC/AJCC TNM staging system [23].…”

Section: Histological Examinationmentioning

confidence: 99%

Prognostic Value of Pretreatment Overweight/obesity and Adipose Tissue Distribution in Resectable Gastric Cancer: A Retrospective Cohort Study

Zhang

Hong

et al. 2021

Preprint

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Background: This is a study aimed at exploring the relationship between pretreatment overweight/obesity, adipose tissue distribution, and long-term prognosis of gastric cancer.Methods: A total of 607 gastric cancer patients were involved in the retrospective cohort study. Overweight/obese patients was defined as body mass index (BMI) greater than 25 kg/m2 and adipose tissue distribution parameters, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio were measured at the level of the third lumbar vertebra using computerized tomography images within 15 days before the surgery. Multiple Cox regression models were applied to evaluate the association between overweight/obesity and disease-specific survival (DSS) of gastric cancer and covariates including age, gender, T stage, N stage, and chemotherapy were adjusted. Furthermore, multiple Cox regression models were performed to evaluate the association between adipose tissue distribution parameters and DSS of gastric cancer, expect for covariates mentioned above, overweight/obesity was adjusted additionally.Results: Overweight/obesity was a protective factor (HR = 0.61, 95% CI: 0.37-0.99) for the prognosis of gastric cancer. While high SAT percentage was independently related to a good prognosis, high VAT percentage and high VAT/SAT ratio were independently related to poor prognosis of resectable gastric cancer.Conclusion: These results suggest that overweight/obesity is a protective factor for the prognosis of gastric cancer. The VAT/SAT ratio could be used as a promising prognostic factor for gastric cancer. Therefore, in preoperative evaluation of gastric cancer patients, attention should be paid not only to BMI but also to adipose tissue distribution.

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Validation of the American Joint Committee on Cancer (AJCC) 8th edition stage system for gastric cancer patients: a population-based analysis

Abstract: The AJCC 8th stage system for gastric cancer performs as well as the AJCC 7th edition in the United States (USA). Importantly, when more than 15 lymph nodes are examined, the discriminatory performance of the new edition is improved.

Cited by 49 publications

References 41 publications

Prognostic factors in stage I gastric cancer: A retrospective analysis

Prognostic factors in stage I gastric cancer: A retrospective analysis

Impact of multisection and immunohistochemistry in lymph node staging of Gastric Carcinoma – Case series

Prognostic Value of Pretreatment Overweight/obesity and Adipose Tissue Distribution in Resectable Gastric Cancer: A Retrospective Cohort Study

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