Abstract
Tumor diameter or T stage does not reflect the actual tumor burden and is not able to estimate accurate prognosis of gastric cancer. The current study aimed to evaluate the prognostic value of tumor volume (V) for gastric cancer. A total of 3409 enrolled gastric cancer patients were randomly divided into training set (n = 1705) and validation set (n = 1704). Tumor volume was calculated by the formula V = Tumor diameter × (T stage)2/2. The survival predictive accuracy and prognostic discriminatory ability between different variables and staging systems were analyzed. Four optimal cutoff points for V were obtained in training set (3.5, 8.6, 25.0, 45.0, all P < 0.001). V stage was significantly associated with tumor location, macroscopic type, differentiation degree, tumor diameter, T stage, N stage, vessel invasion, neural invasion and TNM stage (all P < 0.001). V stage was an independent prognostic factor both in training and validation set. V stage showed better predictive accuracy and prognostic discriminatory ability than tumor diameter and T stage. VNM staging system also have advantages in predictive accuracy and prognostic discriminatory ability than TNM staging system. The VNM multivariable model represent good agreement between the predicted survival and actual survival. In conclusion, tumor volume was significantly associated with clinicopathological features and prognosis of gastric cancer. In comparison with TNM staging system, VNM staging system could improve the predictive accuracy and prognostic discriminatory ability for gastric cancer.
Highlights
Till the most commonly used classification is Tumor-nodes-metastasis classification (TNM) staging system including T stage, N stage and distant metastasis, which was recommended by American JointCommittee on Cancer (AJCC) [10] and Japanese GastricCancer Association (JGCA) [11]
Tumor volume was calculated by the formula
Tumor volume was significantly associated with clinicopathological features and prognosis of gastric cancer
Summary
The most commonly used classification is TNM staging system including T stage, N stage and distant metastasis, which was recommended by American JointCommittee on Cancer (AJCC) [10] and Japanese GastricCancer Association (JGCA) [11]. The tumor diameter, as an important prognostic factor which was demonstrated in many other tumors [12,13,14,15] as well as gastric cancer [16], has not been included in the TNM staging system yet. A variety of factors have been adequately analyzed in order to evaluate their predictive value of prognosis for gastric cancer, including tumor diameter [2], T stage [3], N stage [4], tumor markers [5, 6] and other novel indexes [7,8,9]. Www.impactjournals.com/oncotarget prognostic value of tumor volume and VNM for gastric cancer. The clinicopathological characteristics were comparable between training and validation set (Table 1)
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