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J Cancer 2018; 9(19):3570-3576. doi:10.7150/jca.26351 This issue Cite

Research Paper

Proposal for a New TNM Stage based on the 7^th and 8^th American Joint Committee on Cancer pTNM Staging Classification for Gastric Cancer

Miao-Zhen Qiu^1*, Zi-Xian Wang^1*, Yi-Xin Zhou^2*, Da-Jun Yang^3✉, Feng-Hua Wang^1✉, Rui-Hua Xu^1✉

1. Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China.;
2. Department of VIP, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China.;
3. Department of Experimental Research, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
*Miaozhen Qiu, Zi-Xian Wang and Yi-Xin Zhou contributed equally to the manuscript.

✉ Corresponding authors: Professor Da-jun Yang, MD, PhD, Department of Experimental Research, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China. Tel.: +86 20 8734 2285; Fax: +86 20 8734 2285; E-mail: yangdjorg.cn, Professor Feng-Hua Wang, Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China. Tel.: +86 20 8734 2490; Fax: +86 20 8734 2490; E-mail: wangfhorg.cn, Professor Rui-Hua Xu, Department of Medical Oncology, Sun Yat-Sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, China. Tel: +86-20-8734 3333; Fax: +86-20-8734 3295; E-mail: xurhorg.cn More

Abstract

Background: The 8^th edition of the American Joint Committee on Cancer (AJCC) staging system for gastric cancer incorporated several new changes. We aimed to assess the comparative prognostic values of the 7^th and 8^th AJCC pTNM staging systems in patients with gastric cancer (GC), and accordingly, to put forward a refined staging classification.

Methods: The SEER database was queried to identify GC patients between 2004 and 2009. GC patients from Sun Yat-sen University Cancer Center (SYSUCC) were used as external validation data. The Kaplan-Meier method and Cox proportional hazards regression models were used to analyze cause-specific survival (CSS). The prognostic performance of different staging schemes was assessed using the concordance index (c-index), Akaike's information criterion (AIC), and likelihood ratio χ² test.

Results: In the SEER cohort, stage migration occurred in 8.74% of patients. Survival analysis showed that it was better to treat T4bN0M0 + T4aN2M0 as stage IIIB and T4bN3bM0 as stage IV. Based on this, we established a new staging system which exhibited a superior c-index (0.7501) to the 7^th and 8^th AJCC staging systems (0.7498 and 0.7500, respectively). The new staging system also outperformed the 7^th and 8^th AJCC staging systems in terms of AIC and the likelihood ratio χ² test. The predictive superiority of the new staging system remained valid in the SYSUCC database.

Conclusions: We demonstrated that some stage modifications in the 8^th AJCC pathologic staging were unnecessary. Therefore we established a new staging system, which was superior to the 7^th and 8^th staging systems.

Keywords: Gastric Cancer, Prognosis, SEER, TNM staging classification

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