Is the AJCC TNM staging system still appropriate for gastric cancer patients survival after 5 years?
Introduction
Gastric cancer (GC) is the fifth most common malignancy and the third most common cause of cancer-related death worldwide [1]. In recent years, with the development of social economy and medical treatment, gastric cancer has been diagnosed earlier. In addition, the multimodal treatments for gastric cancer, especially new chemotherapeutic and biologic compounds, led to dramatically improve the patients’ survival. More gastric cancer patients obtain longer-term survival. Accurate staging is critical for predicting the prognosis of malignant tumors, clinical decision making and determining surveillance strategy. The American Joint Committee on Cancer (AJCC) tumor-lymph node-metastasis (TNM) classification is currently the most important prognostic indicator for gastric cancer [2]; it is based on pathological and survival data after surgery (gradually based on 5-year overall survival). However, the risk of death changes over time, and survival probability for patients who already have survived for several years may change with respect to the probability predicted immediately after surgery [3]. Whether the AJCC classification can still provide a valid assessment of long-term prognosis in patients who have survived a specified period of time after surgery has not yet been reported. Therefore, the purpose of this study was to evaluate the changes in long-term prognosis and the prognostic value of the AJCC staging system for GC patients with prolongation of survival time after surgery to provide a more accurate staging system for patients who survive a long time after surgery.
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Study population
We retrospectively assessed all patients with resectable GC who were treated between January 1997 and December 2013 at Fujian Medical University Union Hospital (FMUUH). The inclusion criteria were defined as follows: (1) the presence of primary gastric cancer, (2) no distant metastasis, (3) R0 resection (no residual macroscopic or microscopic tumor), and (4) records of all relevant values. The following exclusion criteria were applied: (1) neoadjuvant chemotherapy, (2) histological
Clinicopathological characteristics
A total of 4556 patients were included in the development cohort (Supplemental Table 1). Of these patients, 3463 (76.0%) were male and 1093 (24.0%) were female. The mean patient age at the time of surgery was 59.5 years. Based on the primary site of gastric cancer, 1866 (41.0%), 745 (16.4%), 1317 (28.9%) and 628 (13.8%) had tumors located at lower-third (L), middle-third (M), upper-third (U) and two or more positions of the stomach, respectively. In terms of surgery, 2020 (44.3%) patients
Discussion
In recent years, the standard surgical approach and several adjuvant therapy patterns suggested for the treatment of gastric cancer led to improved survival rates; the 5-year survival rates for patients with gastric cancer has exceeded 50% [[9], [10], [11], [12]]. The AJCC TNM classification is important for assessing prognosis and determining appropriate treatment options for patients with gastric cancer; the 8th edition of the AJCC TNM classification system was published in 2016 [2]. For
Author contributions
Lin JX, Lin JP, Zheng CH, Huang CM and Li P conceived of the study, analyzed the data, and drafted the manuscript; Tu RH, Li P, Xie JW, Wang JB, and Li P helped revise the manuscript critically for important intellectual content; Lu J, Chen QY, Cao LL, and Lin M helped collect data and design the study.
Conflict of interest
There are no conflicts of interest or financial ties to disclose from any of author.
Human rights statement and informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.
Acknowledgements
A Scientific and technological innovation joint capital projects of Fujian Province, China (No.2016Y9031). Minimally invasive medical center of Fujian Province (No. [2017]171). The Science Foundation of the Fujian Province, China (Grant No. 2018J01307). Startup Fund for scientific research, Fujian Medical University (No. 2016QH024).
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Revisiting the 8th AJCC system for gastric cancer: A review on validations, nomograms, lymph nodes impact, and proposed modifications
2022, Annals of Medicine and SurgeryCitation Excerpt :However, the new edition isn't entirely superior, as other studies indicating comparable c-index values and similar long-term prognostic performance to previous editions [31,32]. Several modifications in the pTNM have been suggested to improve its discriminatory ability and prognostic stratification [33–35]. These propositions followed a wide variation in the median overall survival of patients at the same stage between different sub-classes, especially in stage III, and similar survival rates between stages IIIC and IV.
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Lin JX and Lin JP contributed equally to this work and should be considered co-first authors.