Abstract
BackgroundWe investigated the superiority of the 8th edition of the tumor-node-metastasis (TNM) system for patients in China with gastric cancer.MethodsThe survival outcomes of 1663 patients with gastric cancer undergoing radical resection were analyzed.ResultsIn the 8th edition system, homogeneous 5-year survival rates among different pathological TNM (pTNM) categories belonging to the same stage were observed. However, in the 7th edition system, the differences of 5-year survival rate among pTNM categories belonging to the same stage were observed in stages IIB (P = 0.010), IIIB (P = 0.004), and IIIC (P < 0.001). For patients in the pT1-3 (P < 0.001) and pT4a (P < 0.001) categories, there were significant differences in survival between patients in the pN3a and pN3b categories. Furthermore, partial cases (pT4bN0M0/T4aN2M0) of stage IIIB were downstaged to stage IIIA in the 8th edition system, and the 5-year survival rate of these patients was significantly better than that of patients in stage IIIB in the 8th edition system. Similarly, the 5-year survival rate of patients in p4bN2M0/T4aN3aM0 downstaged from stage IIIC to IIIB was significantly better than that of patients in stage IIIC. Compared with the 7th edition system, the 8th edition system had a higher likelihood ratio and linear trend chi-squared score and a smaller Akaike information criteria value.ConclusionsThe 8th edition system is superior to the 7th edition system in terms of homogeneity, discriminatory ability, and monotonicity of gradients for Chinese patients with gastric cancer.
Highlights
The incidence of gastric cancer is declining, it remains the fourth most common malignancy worldwide, with nearly 950,000 new cases diagnosed each year [1,2,3,4]
Eligibility criteria included (1) gastric adenocarcinoma identified by histopathological examination, (2) no distant metastasis, (3) radical resection, (4) gastrectomy and lymphadenectomy based on Japanese Gastric Cancer treatment guidelines [16], (5) more than 15 harvested lymph nodes, (6) no other synchronous malignancy, (7) no death in the postoperative period, (8) no preoperative chemotherapy or radiotherapy, and (9) tumors located in the stomach or esophagogastric junction (EGJ) tumors recommended for the use of the stomach schema in the 8th edition staging system
We found that the largest subgroup of stage III in the 7th edition was IIIC (n = 457), whereas the largest subgroup of stage III in the 8th edition was IIIA (n = 476)
Summary
The incidence of gastric cancer is declining, it remains the fourth most common malignancy worldwide, with nearly 950,000 new cases diagnosed each year [1,2,3,4]. There are doubts that cancer of the esophagogastric junction (EGJ), especially Siewert types 2 and 3, should be classified by the gastric staging system [12] Another important point is regarding subgroups pN3a and pN3b. Results In the 8th edition system, homogeneous 5-year survival rates among different pathological TNM (pTNM) categories belonging to the same stage were observed. In the 7th edition system, the differences of 5-year survival rate among pTNM categories belonging to the same stage were observed in stages IIB (P = 0.010), IIIB (P = 0.004), and IIIC (P < 0.001). Partial cases (pT4bN0M0/T4aN2M0) of stage IIIB were downstaged to stage IIIA in the 8th edition system, and the 5-year survival rate of these patients was significantly better than that of patients in stage IIIB in the 8th edition system. Conclusions The 8th edition system is superior to the 7th edition system in terms of homogeneity, discriminatory ability, and monotonicity of gradients for Chinese patients with gastric cancer
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