Abstract
Background and ObjectivesThe eighth TNM edition for gastric cancer was released in 2016 and included major revisions, especially of stage III. The purpose of this study was to evaluate the prognostic value of the new AJCC TNM classification in comparison with the 7th edition for stage III gastric cancer.MethodsClinical and histopathological data on 1,496 patients operated on for stage III GC according to the seventh edition between 2005 and 2013 were analyzed and compared using 7th and 8th classifications. The 2 systems were compared in terms of prognostic performance.ResultsThe stage shifted for 650 (43.45%) patients: from IIIA to IIIB (2 patient, 0.13%), from IIIB to IIIA (214 patients, 14.30%), from IIIB to IIIC (99 patients, 6.62%), and from IIIC to IIIB (335 patients, 22.39%). Cox regression multivariate analysis showed both the 8th and 7th TNM classification were independent prognostic factors. The 8th edition system had higher linear trend and likelihood ratio χ2 scores, and smaller AIC values compared with those for the 7th edition. However, the performance of the eighth edition did not reveal significant improvement compared to the seventh edition (c-index 0.625 vs. c-index 0.616, p=0.085).ConclusionThe eighth TNM edition may not provide significantly better accuracy in predicting the prognosis of stage III GC. However, to confirm our findings, further studies are warranted.
Highlights
The AJCC TNM system is recognized as the most well-established and well-recognized malignant tumor staging system worldwide
The performance of the eighth edition did not reveal significant improvement compared to the seventh edition (c-index 0.625 vs. c-index 0.616, p=0.085)
The AJCC TNM staging system has been revised continuously, and the most recent eighth edition of the TNM classification published in 2016 replaced the seventh edition from 2009 [1]
Summary
The AJCC TNM system is recognized as the most well-established and well-recognized malignant tumor staging system worldwide. The AJCC published the eighth edition of the TNM classification, and several changes to the 8th www.impactjournals.com/oncotarget edition of the AJCC staging system for gastric cancer have been proposed (Supplementary Table 1) [1]. A key change adopted in new eighth edition details pN3 as pN3a and pN3b in the final pathologic stage. T4aN3aM0 and T4bN2M0 tumors were downstaged from IIIC to IIIB (Figure 1). In the present study, we mainly evaluated classification changes made in regards to stage III gastric cancer. The eighth TNM edition for gastric cancer was released in 2016 and included major revisions, especially of stage III. The purpose of this study was to evaluate the prognostic value of the new AJCC TNM classification in comparison with the 7th edition for stage III gastric cancer
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