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A Comparison of Five Competing Lymph Node Staging Schemes in a Cohort of Resectable Gastric Cancer Patients

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

New classifications for lymph node (LN) staging have recently been proposed to improve upon the UICC/AJCC N category staging convention. Ratio-based systems and logarithmic odds (LODDS) scores are two families of novel competing staging systems. We compared UICC/AJCC staging with 5 ratio and LODDS systems in predicting overall survival (OS) in patients with resected gastric cancer.

Methods

Using a large population-based dataset, we identified 12,184 nonmetastatic resectable gastric cancer patients between 1988 and 2004. We compared each subject’s UICC/AJCC N stage with five novel staging schemes. We analyzed the OS for each method. Our comparison metric was the log-rank Chi squared statistic; larger Chi squared statistics indicate improvements in N stage discrimination.

Results

Median OS was 2.1 years (95 % CI 2.0–2.2 years), while median patient follow-up for surviving patients was 8.3 years (range, 1 month–22 years). Although all 5 staging systems were either comparable or superior to the UICC/AJCC convention, a LN ratio method outperformed others in N stage discrimination based on log-rank tests for OS. This trend was independent of the number of LNs examined.

Conclusions

Novel LN staging methods have a higher degree of discrimination utility than the UICC/AJCC N convention. These methods may have a role in reducing the prognostic impact of LN count variability. Of the systems assessed, the LN ratio system that assigns greater risk attribution to cases with <16 LNs was the best classification method to predict OS in patients with resectable gastric cancer.

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Author information

Authors and Affiliations

  1. Division of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA

    David D. Smith PhD & Rebecca A. Nelson PhD

  2. Department of Surgery, Indiana University School of Medicine South Bend, South Bend, IN, USA

    Roderich E. Schwarz MD, PhD, FACS

  3. IU Health Goshen Center for Cancer Care, Goshen, IN, USA

    Roderich E. Schwarz MD, PhD, FACS

Authors
  1. David D. Smith PhD
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  2. Rebecca A. Nelson PhD
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  3. Roderich E. Schwarz MD, PhD, FACS
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Corresponding author

Correspondence to David D. Smith PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplemental Figure 1: Gastric cancer cohort selection from SEER registry (1988-2004). (TIFF 141194 kb)

10434_2013_3356_MOESM2_ESM.eps

Supplemental Figure 2: Comparison of concordance probabilities of the Cox model among the LN staging systems. Higher numbers show more discrimination utility (EPS 6 kb)

Supplementary material 3 (DOC 124 kb)

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Smith, D.D., Nelson, R.A. & Schwarz, R.E. A Comparison of Five Competing Lymph Node Staging Schemes in a Cohort of Resectable Gastric Cancer Patients . Ann Surg Oncol 21, 875–882 (2014). https://doi.org/10.1245/s10434-013-3356-0

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  • DOI: https://doi.org/10.1245/s10434-013-3356-0

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