Abstract
Background
Since the eighth American Joint Committee on Cancer (AJCC) classification recently introduced the clinical classification for preoperative staging of gastric cancer, the new clinical classification has not been extensively validated yet. Therefore, in this study, we compared the prognostic performance of the new clinical classification and the pathologic classification for preoperative staging of gastric cancer.
Methods
We reviewed 3027 patients with gastric cancer who were surgically treated between 2009 and 2013. Patient survival was analyzed according to the preoperative stage by the clinical classification and the pathologic classification in the eighth AJCC classification. The prognostic performance was examined using the Akaike information criterion (AIC) value and Harrell c-index.
Results
Patient survival was significantly different across the different stages when both classifications were used. However, individual pairwise comparisons showed that survival differences between each stage were more distinctive and homogeneous in the pathologic classification. In the multivariate model adjusted for the final pathologic stage, preoperative staging by the pathologic classification was an independent prognostic factor, whereas the clinical classification was not. The pathologic classification showed a lower AIC value compared with the clinical classification (5100.64 vs. 5114.14). The Harrell c-index was higher in the pathologic classification than in the clinical classification (0.741 vs. 0.739).
Conclusions
The new clinical classification in the eighth AJCC classification discriminates patient survival well. However, it does not appear to have a better prognostic performance compared with the pathologic classification for preoperative staging of gastric cancer.
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References
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424.
Jung KW, Won YJ, Kong HJ, Lee ES. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2015. Cancer Res Treat. 2018;50:303–16.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.
Smyth EC, Verheij M, Allum W, et al. Gastric cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2016;27(Suppl 5):v38–49.
Hallinan JTPD, Venkatesh SK. Gastric carcinoma: imaging diagnosis, staging and assessment of treatment response. Cancer Imaging. 2013;13:212–27.
Ajani J, In H, Sano T, et al. Stomach. AJCC Cancer staging manual, 8th ed. New York: Springer; 2017. p. 203–19.
Bando E, Makuuchi R, Irino T, Tanizawa Y, Kawamura T, Terashima M. Validation of the prognostic impact of the new tumor-node-metastasis clinical staging in patients with gastric cancer. Gastric Cancer. 2019;22:123–9.
In H, Ravetch E, Langdon-Embry M, et al. The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging. Gastric Cancer. 2018;21:1–9.
Kim JW, Shin SS, Heo SH, et al. The role of three-dimensional multidetector CT gastrography in the preoperative imaging of stomach cancer: emphasis on detection and localization of the tumor. Korean J Radiol. 2015;16:80–9.
Antolini L, Boracchi P, Biganzoli E. A time-dependent discrimination index for survival data. Stat Med. 2005;24:3927–44.
Bozdogan H. Model selection and Akaike’s information criterion (AIC): the general theory and its analytical extensions. Psychometrika. 1987;52:345–70.
Kim SG, Seo HS, Lee HH, Song KY, Park CH. Comparison of the differences in survival rates between the 7th and 8th editions of the AJCC TNM staging system for gastric adenocarcinoma: a single-institution study of 5,507 patients in Korea. J Gastric Cancer. 2017;17:212–9.
Lu J, Zheng C-H, Cao L-L, et al. Comparison of the 7th and 8th editions of the American Joint Committee on Cancer TNM classification for patients with stage III gastric cancer. Oncotarget. 2017;8:83555–62.
Park SR, Kim MJ, Ryu KW, et al. Prognostic value of preoperative clinical staging assessed by computed tomography in resectable gastric cancer patients: a viewpoint in the era of preoperative treatment. Ann Surg. 2010;251:428–35.
Bando E, Makuuchi R, Tokunaga M, Tanizawa Y, Kawamura T, Terashima M. Impact of clinical tumor-node-metastasis staging on survival in gastric carcinoma patients receiving surgery. Gastric Cancer. 2017;20:448–56.
Fukagawa T, Katai H, Mizusawa J, et al. A prospective multi-institutional validity study to evaluate the accuracy of clinical diagnosis of pathological stage III gastric cancer (JCOG1302A). Gastric Cancer. 2018;21:68–73.
Sano T, Coit DG, Kim HH, et al. Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer. 2017;20:217–25.
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Jeong, O., Jung, M.R., Kang, J.H. et al. Prognostic Performance of Preoperative Staging: Assessed by Using Multidetector Computed Tomography—Between the New Clinical Classification and the Pathological Classification in the Eighth American Joint Committee on Cancer Classification for Gastric Carcinoma. Ann Surg Oncol 27, 545–551 (2020). https://doi.org/10.1245/s10434-019-07845-3
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DOI: https://doi.org/10.1245/s10434-019-07845-3