Seventh Edition (2010) of the AJCC/UICC Staging System for Gastric Adenocarcinoma: Is there Room for Improvement?
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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.
KeywordsGastric Cancer Staging System Gastric Adenocarcinoma Esophagogastric Junction Seventh Edition
- 1.Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, A Trotti. AJCC Cancer Staging Manual, 7th edn. New York: Springer-Verlag; 2009, p 117–26.Google Scholar
- 2.Green FL, Page DL, Flemming ID, Fritz A, Balch CM, Haller DG, et al. AJCC Cancer Staging Manual, 6th edn. New York: Springer-Verlag; 2002, p 99–103.Google Scholar
- 5.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].Google Scholar
- 11.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.Google Scholar
- 13.California Cancer Registry, 12/11 update. http://www.ccrcal.org. Accessed 9 Nov 2012.
- 14.Office of Statewide Health Planning and Development, update 12/11. http://www.oshpd.ca.gov. Accessed 9 Nov 2012.