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Is the 8th Edition of the AJCC TNM Staging System Sufficiently Reasonable for All Patients with Noncardia Gastric Cancer? A 12,549-Patient International Database Study

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

Abstract

Background

The aim of this work is to compare the prognostic ability between the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) tumor–node–metastasis (TNM) classification for gastric cancer (GC).

Methods

A total of 10,194 noncardia GC patients were identified from the Surveillance, Epidemiology, and End Results database from 1988 to 2008. Concordance index (C-index), bayesian information criterion (BIC), and time-dependent receiver operating characteristic (t-ROC) analyses were used. External validation was performed using a dataset (n = 2355) derived from Fujian Medical University Union Hospital.

Results

Overall survival for all five AJCC N categories differed significantly when patients were subgrouped into ≤ 15 versus >15 examined lymph nodes (eLNs). The prognostic ability of the 8th edition (C-index 0.716) was not improved over the 7th edition (C-index 0.716). Subgroup analysis showed superior performance of the 8th over the 7th edition in patients with > 15 eLNs (C-index 0.742 vs. 0.735); however, the two editions showed similar performance for patients with ≤ 15 eLNs (C-index 0.713 vs. 0.713). The BIC and t-ROC analyses were consistent. To better predict the prognosis of patients with ≤ 15 eLNs, we established a novel prognostic model based on independent prognostic factors (C-index 0.735). BIC analysis showed that this new model was better than the 7th and 8th editions. Similar results were obtained from the validation set.

Conclusions

The 8th edition of the AJCC TNM classification shows better prognostic ability than the 7th edition in noncardia GC patients with > 15 eLNs, but no improvement was found in patients with ≤ 15 eLNs; therefore, a novel prognostic model is proposed.

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Funding

This work was supported by the Scientific and technological innovation joint capital projects of Fujian Province (2016Y9031), construction Project of Fujian Province Minimally Invasive Medical Center (No. [2017]171), the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013), youth scientific research subject of Fujian provincial health and family planning commission (No. 2015-1-37), QIHANG funds of Fujian Medical University (No. 2016QH025), and Joint Health Programs of the Provincial Natural Foundation (2015J01464).

Disclosures

All the authors declare that they have no potential commercial conflicts of interest relevant to this article.

Author information

Author notes

  1. Jun Lu and Zhi-Fang Zheng contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China

    Jun Lu MD, Zhi-Fang Zheng MD, Jian-Wei Xie PhD, Jia-Bin Wang PhD, Jian-Xian Lin MD, Qi-Yue Chen MD, Long-Long Cao MD, Mi Lin MD, Ru-Hong Tu MD, Chang-Ming Huang MD, Chao-Hui Zheng PhD & Ping Li PhD

  2. Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Jun Lu MD, Zhi-Fang Zheng MD, Jian-Wei Xie PhD, Jia-Bin Wang PhD, Jian-Xian Lin MD, Qi-Yue Chen MD, Long-Long Cao MD, Mi Lin MD, Ru-Hong Tu MD, Chang-Ming Huang MD, Chao-Hui Zheng PhD & Ping Li PhD

  3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China

    Jia-Bin Wang PhD, Jian-Xian Lin MD, Chang-Ming Huang MD, Chao-Hui Zheng PhD & Ping Li PhD

  4. Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China

    Jia-Bin Wang PhD, Jian-Xian Lin MD, Chang-Ming Huang MD, Chao-Hui Zheng PhD & Ping Li PhD

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  1. Jun Lu MD
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Corresponding authors

Correspondence to Chang-Ming Huang MD, Chao-Hui Zheng PhD or Ping Li PhD.

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Lu, J., Zheng, ZF., Xie, JW. et al. Is the 8th Edition of the AJCC TNM Staging System Sufficiently Reasonable for All Patients with Noncardia Gastric Cancer? A 12,549-Patient International Database Study. Ann Surg Oncol 25, 2002–2011 (2018). https://doi.org/10.1245/s10434-018-6447-0

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