Seventh Edition (2010) of the AJCC/UICC Staging System for Gastric Adenocarcinoma: Is there Room for Improvement?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The gastric cancer AJCC/UICC staging system recently underwent significant revisions, but studies on Asian patients have reported a lack of adequate discrimination between various consecutive stages. We sought to validate the new system on a U.S. population database.
California Cancer Registry data linked to the Office of Statewide Health Planning and Development discharge abstracts were used to identify patients with gastric adenocarcinoma (esophagogastric junction and gastric cardia tumors excluded) who underwent curative-intent surgical resection in California from 2002 to 2006. AJCC/UICC stage was recalculated based on the latest seventh edition. Overall survival probabilities were calculated using the Kaplan–Meier method.
Of 1905 patients analyzed, 54 % were males with a median age of 70 years. Median number of pathologically examined lymph nodes was 12 (range, 1–90); 40 % of patients received adjuvant chemotherapy, and 31 % received adjuvant radiotherapy. The seventh edition AJCC/UICC system did not distinguish outcome adequately between stages IB and IIA (P = 0.40), or IIB and IIIA (P = 0.34). By merging stage II into 1 category and moving T2N1 to stage IB and T2N2, T1N3 to stage IIIA, we propose a new grouping system with improved discriminatory ability
In this first study validating the new seventh edition AJCC/UICC staging system for gastric cancer on a U.S. population with a relatively limited number of lymph nodes examined, we found stages IB and IIA, as well as IIB and IIIA to perform similarly. We propose a revised stage grouping for the AJCC/UICC staging system that better discriminates between outcomes.
- Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti, A (2009) AJCC Cancer Staging Manual. Springer-Verlag, New York
- Green, FL, Page, DL, Flemming, ID, Fritz, A, Balch, CM, Haller, DG (2002) AJCC Cancer Staging Manual. Springer-Verlag, New York
- Ahn, HS, Lee, HJ, Hahn, S, Kim, WH, Lee, KU, Sano, T (2010) Evaluation of the seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 116: pp. 5592-5598 CrossRef
- Fang, WL, Huang, KH, Chen, JH, Lo, SS, Hsieh, MC, Shen, KH (2011) Comparison of the survival difference between AJCC 6th and 7th editions for gastric cancer patients. World J Surg. 35: pp. 2723-2729 CrossRef
- Jung H, Lee HH, Song KY, Jeon HM, Park CH. Validation of the seventh edition of the American Joint Committee on Cancer TNM staging system for gastric cancer. Cancer. 2011. [Epub Ahead of Print].
- Kim, DH, Oh, CA, Oh, SJ, Choi, MG, Noh, JH, Sohn, TS (2012) Validation of seventh edition AJCC gastric cancer staging modifications. J Surg Oncol. 105: pp. 26-30 CrossRef
- Wang, W, Sun, XW, Li, CF, Lv, L, Li, YF, Chen, YB (2011) Comparison of the 6th and 7th editions of the UICC TNM staging system for gastric cancer: results of a Chinese single-institution study of 1,503 patients. Ann Surg Oncol. 18: pp. 1060-1067 CrossRef
- Marchet, A, Mocellin, S, Ambrosi, A, Morgagni, P, Vittimberga, G, Roviello, F (2011) Validation of the new AJCC TNM staging system for gastric cancer in a large cohort of patients (n = 2,155): focus on the T category. Eur J Surg Oncol. 37: pp. 779-785 CrossRef
- McGhan, LJ, Pockaj, BA, Gray, RJ, Bagaria, SP, Wasif, N (2012) Validation of the updated 7th edition AJCC TNM staging criteria for gastric adenocarcinoma. J Gastrointest Surg. 16: pp. 53-61 CrossRef
- Kikuchi, S, Futawatari, N, Sakuramoto, S, Katada, N, Yamashita, K, Shibata, T (2011) Comparison of staging between the old (6th edition) and new (7th edition) TNM classifications in advanced gastric cancer. Anticancer Res. 31: pp. 2361-2365
- Yoon HM, Ryu KW, Nam BH, Cho SJ, Park SR, Lee JY, et al. Is the new seventh AJCC/UICC staging system appropriate for patients with gastric cancer? J Am Coll Surg. 2012;2012;214:88–96.
- Strong, VE, Song, KY, Park, CH, Jacks, LM, Gonen, M, Shah, M (2010) Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg. 251: pp. 640-646 CrossRef
- California Cancer Registry, 12/11 update. http://www.ccrcal.org. Accessed 9 Nov 2012.
- Office of Statewide Health Planning and Development, update 12/11. http://www.oshpd.ca.gov. Accessed 9 Nov 2012.
- Deyo, RA, Cherkin, DC, Ciol, MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 45: pp. 613-619 CrossRef
- Washington, K (2010) 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 17: pp. 3077-3079 CrossRef
- Warneke, VS, Behrens, HM, Hartmann, JT, Held, H, Becker, T, Schwarz, NT (2011) Cohort study based on the seventh edition of the TNM classification for gastric cancer: proposal of a new staging system. J Clin Oncol. 29: pp. 2364-2371 CrossRef
- Biondi, A, Hyung, WJ (2011) Seventh Edition of TNM Classification for Gastric Cancer. J Clin Oncol. 29: pp. 4338-4339 CrossRef
- Kattan, MW, Karpeh, MS, Mazumdar, M, Brennan, MF (2003) Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol. 21: pp. 3647-3650 CrossRef
- Seventh Edition (2010) of the AJCC/UICC Staging System for Gastric Adenocarcinoma: Is there Room for Improvement?
Annals of Surgical Oncology
Volume 20, Issue 5 , pp 1631-1638
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Department of Medicine, Division of Oncology, Stanford University Medical Center, Stanford, CA, USA
- 2. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
- 3. Department of Radiation Oncology, Stanford University Medical Center, Stanford, CA, USA