Validation of the American Joint Commission on Cancer (8th edition) changes for patients with stage <scp>III</scp> gastric cancer: survival analysis of a large series from a Specialized Eastern Center

Lü, Jun; Zheng, Chao‐Hui; Cao, Long‐Long; Ling, Shao-Wei; Li, Ping; Xie, Jian‐Wei; Wang, Jia-Bin; Ji, Lin; Chen, Qi‐Yue; Ma, Lin; Tu, Ru‐Hong; Huang, Chang‐Ming

doi:10.1002/cam4.1118

Cited by 14 publications

(7 citation statements)

References 23 publications

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“…However, their conclusion that the 8th TNM edition may not provide better accuracy in predicting the prognosis of stage III gastric cancer is opposite to the findings of the present study. This also suggested a controversy regarding the superiority of the 8th edition and a large-scale, well-designed study is required to further confirm the conclusions, until which time retrospective analyses from different centers, including the present study, may provide insights into this issue (7)(8)(9). In the present study, the suitability of these modifications in the latest 8th edition TNM staging system were evaluated.…”

Section: Discussionmentioning

confidence: 67%

Superiority of the 8th edition of the TNM staging system for predicting overall survival in gastric cancer: Comparative analysis of the 7th and 8th editions in a monoinstitutional cohort

Wang

Guo

et al. 2018

mol clin onc

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The present study was performed to evaluate the predictive capacity of the 8th edition vs. the 7th edition of the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging system for overall survival (OS) of patients with gastric cancer. Data of eligible patients with gastric cancer in our institution between June 2004 and June 2014 were retrospectively reviewed. A total of 1,506 patients were followed up to July 2016, among whom 1,484 patients with complete stage information were included in the TNM staging analysis. A total of 339 (22.8%) patients presented stage migration, including 325 (21.9%) migrating to a lower tier and 14 (0.9%) to a higher tier. All patients with stage migration to a lower tier were in stage III, including 177 (54.5%) patients migrating from stage IIIB to IIIA, and 148 (45.5%) from stage IIIC to IIIB. Patients migrating from IIIB to IIIA yielded a median OS time and 5-year OS rate closer to those remaining in stage IIIA. Similarly, patients migrating from IIIC to IIIB yielded a median OS time and 5-year OS rate closer to those remaining in stage IIIB. The 7th edition of the staging system exhibited prognostic discrepancy in discriminating stage IIIA from IIIB on survival curves, which was improved in the 8th edition. The 8th edition had a better predictive capability of survival, as evidenced by a smaller value of -2log likelihood in the Cox proportional regression model (7th edition 4738.859 vs. 8th edition 4736.683). Therefore, the present study demonstrated that the 8th edition of the AJCC TNM staging system is superior to the 7th edition in predicting the OS of patients with gastric cancer.

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Section: Discussionmentioning

confidence: 67%

Superiority of the 8th edition of the TNM staging system for predicting overall survival in gastric cancer: Comparative analysis of the 7th and 8th editions in a monoinstitutional cohort

Wang

Guo

et al. 2018

mol clin onc

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“…The placement of some pN3a patients was revised into stage IIIB, and pT3-4bN3bM0 was classified as stage IIIC [12]. Although previous studies have confirmed the prognostic value of the 8th AJCC stage system for gastric cancer (GC), it is mostly confined to patients with stage III [31], lymph node negative or lymph node the 15-Lymph Node Minimum [32,33]. Our study firstly evaluated the prognostic value of the 8th AJCC stage system for resectable GC from multicenter database.…”

Section: Discussionmentioning

confidence: 99%

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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“…The TNM system is widely used to offer guidance for the treatment of gastric cancer (7). The 8th edition of the TNM staging system for gastric cancer was released in 2016, replacing the 2009 7th edition (8). Compared with the previous edition, the 8th edition has no changes in the definition of T and N classifications.…”

Section: Discussionmentioning

confidence: 99%

“…The 8th edition of the tumor-node-metastasis (TNM) staging system (5), established by the American Joint Committee on Cancer and the Union for International Cancer Control (UICC), is the most commonly used system for predicting the prognosis of gastric cancer (6). The 8th edition TNM staging system is considered to be an objective and reliable method for predicting the prognosis of patients with gastric cancer (7), however, the requirement of at least 15 retrieved lymph nodes (LNs) limits the use of this system in clinical practice (8). Furthermore, stage migration may occur if a low number of LNs are retrieved, which may underestimate the severity of the disease (9).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the 8th union for international cancer control lymph node staging system for gastric cancer with two other lymph node staging systems

Cao

Tang

et al. 2018

Oncol Lett

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The log odds of positive lymph nodes (LODDS) and the metastatic lymph node ratio (MLR) staging systems have previously been demonstrated to exhibit advantages compared with the tumor-node-metastasis (TNM) staging system in predicting the prognosis of gastric cancer. The current study compared the prognostic significance of the newest Union for International Cancer Control Node classification with the LODDS and MLR staging systems. From September 2010 to December 2012, all medical records for patients with gastric cancer at the Third Affiliated Hospital of Soochow University were retrospectively analyzed and the clinicopathologic characteristics were reviewed. Cutoff points were selected to divide the patients with gastric cancer into different groups. Univariate and multivariate analyses were performed to identify the prognostic risk factors for gastric cancer. The Harrell's concordance index (C-index) was adopted to compare the prognostic value of the three staging systems. A total of 877 patients with gastric cancer who met the inclusion criteria were analyzed in the current study. The patients were classified according to the three MLR subgroups as follows: MLR0 (MLR=0), MLR1 (00.5). Based on multivariate analysis, LODDS, MLR and pathological node (pN) stage could significantly predict survival rates of patients with gastric cancer. According to the C-index, the LODDS staging system more accurately predicted the 5-year overall survival for patients with gastric cancer compared with the other two staging systems. In summary, the current study has identified that LODDS may be superior to the MLR and pN staging systems in predicting the prognosis of patients with gastric cancer. However MLR may exhibit advantages compared with LODDS for patients who have undergone adequate lymphadenectomies.

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Validation of the American Joint Commission on Cancer (8th edition) changes for patients with stage III gastric cancer: survival analysis of a large series from a Specialized Eastern Center

Cited by 14 publications

References 23 publications

Superiority of the 8th edition of the TNM staging system for predicting overall survival in gastric cancer: Comparative analysis of the 7th and 8th editions in a monoinstitutional cohort

Superiority of the 8th edition of the TNM staging system for predicting overall survival in gastric cancer: Comparative analysis of the 7th and 8th editions in a monoinstitutional cohort

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

Comparison of the 8th union for international cancer control lymph node staging system for gastric cancer with two other lymph node staging systems

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