Prognostic Discrepancy of the 6th and 7th UICC N Classification for Lymph Node Staging in Gastric Cancer Patients after Curative Resection

Background: The validity of N classification of the 7th edition of the American Joint Committee on Cancer/Union Internationale contre le Cancer (AJCC/UICC) tumor-node-metastasis (TNM) staging system is still under debate. The purpose of this study was to evaluate the prognostic efficacy of the 7th edition of the AJCC/UICC TNM staging system (focusing on N stage), in comparison with the 6th edition, at a single Eastern institution. Methods: We analyzed 1,435 patients with gastric cancer who underwent curative resection performed from September 1998 to August 2003 at the Memorial Jin-Pok Kim Korea Gastric Cancer Center. We analyzed the survival rate of the patients according to the AJCC/UICC 6th and 7th editions, and compared each stage, focusing on N stage. Results: Significant differences in the 5-year survival rates were observed between the 6th and the 7th AJCC/UICC staging system. In the 6th edition staging system, the Kaplan-Meier curves discriminated each N stage significantly. In contrast, there was no difference in terms of survival curves for N stage according to the 7th edition, especially between N1 and N2: the Kaplan-Meier plots of survival curves between N1 (77.0%) and N2 (78.1%) stages overlapped significantly (p < 0.05). Conclusion: Although the 7th UICC staging system is a more detailed and sophisticated system in the T category, there was no prognostic significance between the pN1 and pN2 stages according to our data. Therefore, we suggest establishing a new UICC staging system taking into consideration the application of the N stage.

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Is Preoperative Fibrinogen Associated with the Survival Prognosis of Gastric Cancer Patients? A Multi-centered, Propensity Score-Matched Retrospective Study

World Journal of Surgery ◽

10.1007/s00268-019-05191-9 ◽

2019 ◽

Vol 44 (1) ◽

pp. 213-222

Author(s):

Lin-Yong Zhao ◽

Yong-Liang Zhao ◽

Jun-Jiang Wang ◽

Qi-Di Zhao ◽

Wen-Qi Yi ◽

...

Keyword(s):

Gastric Cancer ◽

Propensity Score ◽

Cancer Patients ◽

Prognostic Significance ◽

Staging System ◽

Tnm Staging ◽

Plasma Fibrinogen ◽

Tnm Staging System ◽

N Stage ◽

Gastric Cancer Patients

Abstract Background The prognostic significance of preoperative plasma fibrinogen in patients with operable gastric cancer remains under debate. This study aimed to elucidate the prognostic value of fibrinogen in gastric cancer patients underwent gastrectomy. Methods A total of 4351 patients with gastric cancer collected from three comprehensive medical centers were retrospectively evaluated. Patients were categorized by minimum P value using X-tile, while the baseline confounders for fibrinogen was balanced through propensity score matching (PSM). The relationships between fibrinogen and other clinicopathologic features were evaluated, and nomogram was constructed to assess its prognostic improvement compared with TNM staging system. Results Fibrinogen was significantly correlated with macroscopic type, tumor differentiation, tumor size, and T and N stage. The factors, fibrinogen and T stage as well as N stage, were identified to be independent prognostic factors after PSM. Nomogram based on fibrinogen demonstrated a smaller Akaike information criterion (AIC) and a larger concordance index (C-index) than TNM staging system, illustrating that fibrinogen might be able to improve the prognostic accuracy. Conclusions Preoperative plasma fibrinogen levels in gastric cancer patients were significantly correlated with tumor progression, which could be regarded as a reliable marker for survival prognostic prediction.

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Does the New UICC/AJCC TNM Staging System (7th Edition) Improve Assessing Prognosis in Gastric Cancer Compared to the Old System (6th Edition)?

Journal of the Korean Gastric Cancer Association ◽

10.5230/jkgca.2009.9.4.159 ◽

2009 ◽

Vol 9 (4) ◽

pp. 159 ◽

Cited By ~ 9

Author(s):

Tae Kyung Ha ◽

Hyun Ja Kim ◽

Sung Joon Kwon

Keyword(s):

Gastric Cancer ◽

Staging System ◽

Tnm Staging ◽

7Th Edition ◽

Tnm Staging System

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A proposal for a novel and simple TNM staging for gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.21 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 21-21 ◽

Cited By ~ 1

Author(s):

Taeil Son ◽

Jiyu Sun ◽

Hyoung-Il Kim ◽

Jong Won Kim ◽

Jae-Ho Cheong ◽

...

Keyword(s):

Gastric Cancer ◽

Metastatic Lymph Node ◽

Stage Iv ◽

Staging System ◽

Tnm Staging ◽

Rank Test ◽

Discrimination Power ◽

Tnm Staging System ◽

N Classification ◽

T Classification

21 Background: Current TNM staging system for gastric cancer has controversies regarding N classification. We aimed to develop a simple and novel TNM staging system for gastric cancer by re-grouping N classification. Methods: We retrospectively reviewed 14260 patients treated for gastric cancer. To develop simple combinations of TNM staging with similar weighted value between T and N classification, N classification was restructured with different cutoffs. The optimal cutoffs for the number of metastatic lymph node which maximize the x2 statistic of log-rank test for survival differences among patients were selected. C-statistic was used to compare the discriminating performance of the proposed N classification with the current N classification in the TNM staging system. We performed validation with 2 external datasets from a hospital in Korea (n = 1500) and SEER (n = 11324). Results: We identified the new cutoffs of N classification as 1~4, 5~10, 11~24, and 25 or more for N1, N2, N3a, and N3b, respectively. We found survival of the new N3b classification was similar to M1, regardless of T classification. Thus, we stratified these groups of N3b and M1 disease as stage IV, simultaneously. Our new TNM staging had similar weighted value between T and N classification resulting in simple combinations. (Table) Survival curves of subgroups in the new TNM staging had higher x2 value than current staging system (x2: 8239 vs. 7023, respectively) and homogeneity among subgroups in the same stage increased. However, C-statistics (0.801, 95%CI: 0.795, 0.807) of new model showed similar discrimination power than that (0.797, 95%CI: 0.791, 0.803) in 7th TNM staging system. C-statistics were also similar in other hospital in Korea (0.805 vs. 0.802, respectively) and SEER database (0.709 vs. 0.706, respectively). Conclusions: This novel staging system by recalculating cut-offs of N classification provides exceptionally simple and practical way to stratify substages in TNM staging for gastric cancer. [Table: see text]

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RA09.08: EVALUATION OF THE EIGHTH YPTNM CLASSIFICATION SYSTEM IN ESOPHAGEAL CANCER PATIENTS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ra09.08 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 41-42

Author(s):

Motoo Nomura ◽

Shigeru Tsunoda ◽

Katsuyuki Sakanaka ◽

Masashi Tamaoki ◽

Yusuke Amanuma ◽

...

Keyword(s):

Staging System ◽

Tnm Staging ◽

Prognostic Impact ◽

Poor Prognostic Factor ◽

Pathologic Stage ◽

7Th Edition ◽

Tnm Staging System ◽

Staging Systems ◽

Prognostic Group ◽

8Th Edition

Abstract Background The 7th edition of the Union for International Cancer Control (UICC) TNM staging system is based on pathologic data from esophageal cancers treated by surgery alone. In the 8th edition of UICC-TNM staging system, there is no information available for treatment modality (surgery alone or neoadjuvant therapy [NAC] followed by surgery [NAC-S]), although clinical stage, neoadjuvant pathologic stage, and pathologic stage were analyzed and identified. The objective of this study was to evaluate the prognostic impact of the new staging system on esophageal squamous cell cancer (ESCC) patients treated by NAC-S. Methods Database of 140 consecutive ESCC patients in our hospital was retrospectively restaged in 7th and 8th UICC-TNM system. The prognostic impacts of pathologic stage after NAC according to the both staging systems were compared. Results The median follow-up period was 4.8 years (range 0.2–9.7), with 49 patients dead at the time of analysis. In 7th edition, the 3-year overall survival rates (3y-OS) of ypStages 0, I, II, III, and IV were 100%, 93.5%, 93.5%, 43.9%, and 0.0%, respectively. In 8th edition, the 3y-OS of ypStages 0, I, II, III, and IV were 100%, 96.5%, 90.2%, 51.7%, and 29.6%, respectively. There were no marked differences between 7th and 8th edition in the prognoses. The both editions poorly distinguish the prognoses of ypStages 0, I, and II. For pathological prognostic group in 7th edition, the 3y-OS of Groups 0, I, II, III, and IV were 100%, 97.0%, 90.6%, 43.9%, and 0.0%, respectively. For pathological prognostic group in 8th edition, the 3y-OS of Groups 0, I, II, III, and IV were 100%, 96.7%, 89.8%, 51.7%, and 29.6%, respectively. For patients with ypStages 0-II, pretreatment higher CEA was poor prognostic factor (HR 7.1, 95% confidence interval 1.9–25.9). Conclusion Our study indicates the problem that the ypStage in the 8th TNM staging system poorly distinguish the prognoses of ypStages 0, I, and II in patients undergoing NAC-S. Additional study is needed to evaluate the role of ypStage 0-II incorporation of new prognostic factors. Disclosure All authors have declared no conflicts of interest.

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