Improvements to the gastric cancer tumor-node-metastasis staging system based on computer-aided unsupervised clustering

Zhiqiong Wang,Caigang Liu,Huizi Gu,Zhen Xu,Hong Xu,Ying Yu,Junchang Xin,Mo Li,Haitao Zhu,Ping Lu,Yanlin Jiang,Hao Zhang

doi:10.1186/s12885-018-4623-z

Abstract

BackgroundThe Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification is a key gastric cancer prognosis system. This study aimed to create a new TNM system to provide a reference for the clinical diagnosis and treatment of gastric cancer.MethodsA review of gastric cancer patients’ records was conducted in The First Hospital of China Medical University and the Liaoning Cancer Hospital and Institute. Based on patients’ prognoses data, computer-aided unsupervised clustering was performed for all possible TNM staging situations to create a new staging division system.ResultsThe primary outcome measure was 5-year survival, analyzed according to TNM classifications. Computer-aided unsupervised clustering for all TNM staging situations was used to create TNM division criteria that were more consistent with clinical situations. Furthermore, unsupervised clustering for the number of lymph node metastasis in the N stage led to the formulation of a classification method that differs from the existing N stage criteria, and unsupervised clustering for tumor size provided an additional reference for prognosis estimates.ConclusionsFinally, we developed a TNM staging system based on the computer-aided unsupervised clustering method; this system was more in line with clinical prognosis data when compared with the 7th edition of UICC gastric cancer TNM classification.

Highlights

The Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification is a key gastric cancer prognosis system
After adjusting for 16 variables, patient survival was significantly associated with tumor size, tumor site, gross appearance, T stage, N stage, TNM stage, hepatic metastasis, and peritoneum metastasis
We introduced the clustering N stages of N0 (n = 0), N1 (n = 1–4), N2 (n = 5–14), and N3 (n ≥ 15) into the UICC TNM stage, which is “the UICC TNM stage based on the clustering N stage” in Fig. 6, and re-performed the unsupervised clustering for TNM stage, which is “the clustering TNM stage based on the clustering N stage”

Summary

Introduction

The Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) classification is a key gastric cancer prognosis system. This study aimed to create a new TNM system to provide a reference for the clinical diagnosis and treatment of gastric cancer. Based on patients’ prognoses data, computer-aided unsupervised clustering was performed for all possible TNM staging situations to create a new staging division system. In the past 3 decades, both the Japanese and Union for International Cancer Control (UICC) tumor-nodemetastasis (TNM) classification systems for gastric cancer have undergone several major changes [1]. In 2010, the UICC released the 7th edition of TNM classifications of gastric cancer that used the number of metastatic lymph nodes. Tumor size, closely related to the T stage, remains an independent prognosticator in patients with gastric cancer. TNM staging has been revised several times, in clinical practice, there is often a marked difference in the prognoses of patients with the same TNM stage, which might be owing to heterogeneity between patients of different ethnic backgrounds, the

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