Abstract
IntroductionThe 8th edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer introduced changes, mainly in stage III, with the incorporation of the pN3 sub-classification in the final staging group. The goal was to compare the 7th and 8th editions to evaluate the discriminative capacity of the new edition.MethodsThis study was a retrospective review of patients with gastric cancer treated with surgery in 2013 and 2014.ResultsWe analysed 310 patients, with a median age of 66 years and out of which 55.5% were male. The most commonly performed surgery was subtotal gastrectomy (n = 158; 51%), with a median of 30 lymph nodes removed. With a median follow-up of 39.5 months, the 1- and 3-year overall survival (OS) was 82% and 59%, respectively. In stage III (n = 115), there was stage migration in 40 cases (34.8%), with upstage in 11 cases and downstage in 29 cases. In this group, there was a statistically significant difference in OS between N3a and N3b patients (p = 0.002), as well as a statistically significant difference in OS between stages IIIA, IIIB and IIIC when the 8th edition was applied (p = 0.001), which was not verified with the 7th edition (p = 0.057). In multivariate analysis, both extracapsular extension and N classification from TNM were independent prognostic factors (p = 0.033 and p = 0.024, respectively).ConclusionThe 8th edition of the AJCC TNM classification allows for a better prognostic refinement, namely in the new stage III groups after the stratification of lymph node disease in N3a and N3b. Factors that evaluate the biological behaviour of the disease remain excluded from this edition, such as extracapsular extension, which had a prognostic impact in our series.
Highlights
The 8th edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer introduced changes, mainly in stage III, with the incorporation of the pN3 sub-classification in the final staging group
Regarding stage III, in the 7th edition the N3 group was divided between N3a (7–15 positive lymph nodes) and N3b, this subdivision was not taken into account in the final staging
The new edition of the AJCC TNM classification for gastric cancer was largely based on the proposal by Sano et al [11], which was based on a mostly eastern population, raising the question of its applicability in western populations, which is similar to what happened in the transition from the 6th to 7th edition of the classification [12, 13]
Summary
The 8th edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer introduced changes, mainly in stage III, with the incorporation of the pN3 sub-classification in the final staging group. In contrast to other malignant tumours like breast cancer, other factors that could allow for a better prognostic refinement, namely related to the biological behaviour of the disease, remain excluded from this revision of the AJCC classification for gastric cancer [8]
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