scholarly journals A novel pN3 gastric cancer staging system with superior prognostic utility based upon the examination of over 31 lymph nodes: a propensity score-matching analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Qiantao Hu ◽  
Siwei Pan ◽  
Zijun Guo
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Lymph Nodes ◽  
Propensity Score Matching ◽  
Staging System ◽  
Tnm Staging ◽  
Survival Outcomes ◽  
The Novel ◽  
Risk Of Death ◽  
Tnm Staging System

Abstract Background Individuals with pN3 gastric cancer (GC) account for a large proportion of pN + GC, and exhibit poor survival outcomes. The pN3 stage is defined based upon the number of metastatic lymph nodes (mLNs), but the subclassification of pN3 patients based upon the number of examined LNs (eLNs) is rarely performed. Methods In total, 2894 pTxN3M0 GC patients in the Surveillance, Epidemiology, and End Results database that had undergone surgery from 2000 to 2016 were selected for analysis. The X-tile software was used to select the optimal cutoff values. Cox proportional regression analyses were used to evaluated hazard ratios corresponding to the risk of death. Selection bias was minimized via propensity score matching (PSM). Results As the number of eLNs rose, the risk of death for patients trended downwards. Survival analyses indicated that patients with ≤ 31 eLNs exhibited significantly poorer survival outcomes as compared to patients with > 31 eLNs (5-year OS: 18.4% vs. 24.7%), and this result remained significant when analyzing 857 pairs of patients following PSM analysis. Significant differences in prognosis were additionally observed when comparing pN3a and pN3b patients with ≤ 31 or > 31 eLNs under pT3/4a stage. For pT4b stage, pN3a patients with > 31 eLNs also exhibited a better prognosis than other patients. The novel TNM staging system designed exhibited excellent utility as a tool for the prognostic evaluation of this GC patient population. Conclusions These results suggest that in pN3 GC, a minimum of 32 LNs should be examined. The novel TNM staging system for pN3 patients described herein, which was developed based upon the number of eLNs, may thus be of value in clinical settings.

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

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.

A western validation of a novel gastric cancer prognostic model using American data.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 2-2
Author(s):  
Bryan S. Goldner ◽  
Ki Jun Song ◽  
Taeil Son ◽  
Hyoung-Il Kim ◽  
Laleh Melstrom ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Prediction Model ◽  
Cancer Patients ◽  
Staging System ◽  
Tnm Staging ◽  
Prediction Tool ◽  
C Statistic ◽  
Tnm Staging System ◽  
Gastric Cancer Patients

2 Background: A novel prediction model, the Yonsei University Gastric Cancer Prediction Tool was developed by an international collaborative group (G6+) for accurate determination of 5-year overall survival of gastric cancer patients. This prediction model was created using a prospectively maintained single institution database of 12,399 patients and included clinically relevant factors not accounted for in the TNM staging system. This prediction model was validated using external data sets from Asia; its’ applicability in the American population has yet to be determined through a validated data set. Methods: Using the SEER dataset, 2014 release, all patients with gastric adenocarcinoma diagnosed between the years 2002 –2012 who underwent resection were selected. The following characteristics were selected for analysis: age, sex, gender, depth of tumor invasion, number of positive lymph nodes, total lymph nodes retrieved, presence of distant metastasis, extent of resection, and histology. These data were processed through a recently published prognostic nomogram to obtain concordance index (C-statistic) using the bootstrap method and calibration was assessed. This was compared to the current prognostic index, the TNM staging system. Results: A total of 26,019 possible patients were identified from the SEER database, years 2002-2012. Of these, 11,765 had complete datasets. Validation of the prognostication model revealed a C-statistic of 0.762 (95% CI 0.754-0.769). This is compared to the 7thTNM staging model, C-statistic 0.683 (95% CI 0.677-0.689). The new nomogram was found to be significantly more accurate with a p-value of < 0.001. Conclusions: Our study validates a novel prediction model for gastric cancer in the American patient population. Using this model, superior accuracy in prognosticating the 5-year survival of gastric cancer patients was confirmed in the western cohort strongly supporting its global applicability. This model also allows for inclusion of those who did not undergo adequate lymphadenectomy or who underwent a non-curative resection and can be a useful prediction tool for an increasing number of gastric cancer patients world-wide.

Evaluation of the seventh AJCC TNM staging system for gastric cancer: a meta-analysis of cohort studies

Tumor Biology ◽  
2014 ◽  
Vol 35 (9) ◽  
pp. 8525-8532 ◽  
Author(s):  
Jizhun Zhang ◽  
Yangbing Zhou ◽  
Kewei Jiang ◽  
Zhanlong Shen ◽  
Yingjiang Ye ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Staging System ◽  
Tnm Staging ◽  
Tnm Staging System

Rhabdomyosarcoma: the Stanford experience using a TNM staging system.

1986 ◽  
Vol 4 (3) ◽  
pp. 370-378 ◽  
Author(s):  
T J Pedrick ◽  
S S Donaldson ◽  
R S Cox
Keyword(s):  
Lymph Nodes ◽  
Staging System ◽  
Tnm Staging ◽  
Actuarial Survival ◽  
Entire Study ◽  
Histologic Subtype ◽  
Tnm System ◽  
T Stage ◽  
Tnm Staging System ◽  
Extent Of Disease

Seventy-four patients with rhabdomyosarcoma were initially staged according to the Intergroup Rhabdomyosarcoma Study (IRS) grouping classification and then retrospectively using a TNM staging system based on the initial clinical extent of disease. The TNM system includes T1, tumor confined to site or organ of origin; T2, regional extension beyond the site of origin; N0, normal lymph nodes; N1, lymph nodes containing tumor; M0, no evidence of metastases; and M1, distant metastases. All patients received combination chemotherapy, and more than 90% received radiation therapy as part of their initial treatment program with curative intent. Fifty-three of 74 patients (72%) were group III according to the IRS system, indicating unresectable or gross residual tumor. A more uniform distribution was achieved using the TNM system. Freedom from relapse (FFR) was 43% and the actuarial survival rate was 47% for the entire study group at 10 years. All but one relapse occurred within 3 years of initial diagnosis, and only three of 38 relapsed patients were salvaged. All TNM stage I patients are surviving disease free. Among patients having stages II, III, and IV disease by the TNM system, FFR was 53%, 26%, and 11%, and the survival rates were 47%, 36%, and 33%, respectively. Thirty-two of 74 patients (43%) had evidence of lymph node involvement at presentation, and 28 (88%) of these had primary lesions that extended beyond the site of origin (T2 primary). Histologic subtype and primary site had little impact on outcome in a multivariate analysis, and T stage was identified as the single most significant covariate correlated with survival; a model composed of both T stage and M stage was the best one for predicting relapse. The presented data support a study using a prospectively assigned TNM staging system based on the initial clinical extent of disease for use in future therapeutic trials.

scholarly journals A nomogram based on Aspartate Aminotransferase/Alanine Aminotransferase (AST/ALT) ratio after surgery to predict the prognostic value in patients with gastric cancer

2020 ◽  
Author(s):  
Linfang Li ◽  
Shan Xing ◽  
Ning Xue ◽  
Miantao Wu ◽  
Yaqing Liang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Cox Regression ◽  
Staging System ◽  
Tnm Staging ◽  
Calibration Plot ◽  
Study Cohort ◽  
Tnm Staging System ◽  
Resectable Gastric Cancer

Abstract Background This study aimed to develop an effective nomogram for predicting overall survival (OS) in surgically treated gastric cancer. Methods We retrospectively evaluated 190 gastric cancer in this study. Cox regression analyses were performed to identify significant prognostic factors for OS in patients with resectable gastric cancer. The predictive accuracy of nomogram was assessed by calibration plot, concordance index (C-index) and decision curve, and then were compared with the traditional TNM staging system. Based on the total points (TPS) by nomogram, we further divided patients into different risk groups. Results On multivariate analysis of the 190 cohort, independent factors for survival were age, clinical stage and Aspartate Aminotransferase/Alanine Aminotransferase (SLR), which were entered into the nomogram. The calibration curve for the probability of OS showed that the nomogram-based predictions were in good agreement with actual observations. And the C-index of the established nomogram for predicting OS had a superior discrimination power compared with the TNM staging system [0.768 (95% CI: 0.725-0.810) vs 0.730 (95% CI: 0.688-0.772), p < 0.05]. Decision curve also demonstrated that the nomogram was better than TNM staging system. Based on the TPS of the nomogram, we further subdivided the study cohort into 3 groups: low risk (TPS ≤ 158), middle risk (158 < TPS ≤ 188), high risk (TPS > 188), the differences of OS rate were significant in the groups. Conclusions The established nomogram resulted in more accurate prognostic prediction for individual patient with resectable gastric cancer.

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