Dataset Information

Comparative study of the 7th and 8th AJCC editions for gastric cancer patients after curative surgery.

ABSTRACT:

Objectives

The classification of pathological tumor-node-metastasis (pTNM) staging of gastric cancer was revised in the 8th American Joint Committee on Cancer (AJCC) edition. The major revision was the separation of pN3a and pN3b in the pTNM staging. The current study evaluated the prognostic impact of this change.

Methods

A total of 1,517 patients who underwent curative surgery for gastric cancer with a retrieved lymph node number ?15 at our institution from January 1995 to December 2011 were enrolled. Survival was compared for the disease classified according to both the 7th and 8th editions.

Results

After separation of pN3a and pN3b in the pTNM stage definition, the 8th edition still provides significant survival differences between each stage. The multivariate analysis demonstrated that the pTNM stage in both the 7th and 8th editions was an independent prognostic factors of overall survival and disease-free survival. The 8th edition has a better homogeneity than the 7th edition with a significantly higher likelihood ratio chi-square test. Regarding the OS and DFS, the time-dependent receiver operating characteristic (ROC) curves of the two staging systems are almost overlapping, indicating that the prognostic performance is comparable between the two staging systems.

Conclusions

Both the 7th and 8th edition-based stages are independent prognostic factors for gastric cancer. The 8th edition has a better homogeneity than the 7th edition; the 8th edition provides discriminant survival differences among each pTNM stage that are comparable to those in the 7th edition.

SUBMITTER: Fang WL

PROVIDER: S-EPMC5683565 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Publications

Comparative study of the 7th and 8th AJCC editions for gastric cancer patients after curative surgery.

Fang Wen-Liang WL Huang Kuo-Hung KH Chen Ming-Huang MH Liu Chien-An CA Hung Yi-Ping YP Chao Yee Y Tai Ling-Chen LC Lo Su-Shun SS Li Anna Fen-Yau AF Wu Chew-Wun CW Shyr Yi-Ming YM

PloS one 20171113 11

<h4>Objectives</h4>The classification of pathological tumor-node-metastasis (pTNM) staging of gastric cancer was revised in the 8th American Joint Committee on Cancer (AJCC) edition. The major revision was the separation of pN3a and pN3b in the pTNM staging. The current study evaluated the prognostic impact of this change.<h4>Methods</h4>A total of 1,517 patients who underwent curative surgery for gastric cancer with a retrieved lymph node number ≥15 at our institution from January 1995 to Decem ...[more]

PMID: 29131840

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Project description:Background: Considerable modifications have been introduced in the new edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) TNM staging system. Based on the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database, this study aimed to compare the 7th and 8th editions of the AJCC/UICC TNM staging system for patients with papillary thyroid microcarcinoma (PTMC) and follicular variant papillary thyroid microcarcinoma (FVPTMC). Methods: A Data from 2004 to 2014 of 39,032 patients registered in the SEER database were included. The 7th and 8th editions of the AJCC/UICC staging system were compared in terms of TNM staging, age cutoff, and clinical staging. Patient survival was evaluated using Kaplan-Meier and multivariable Cox proportional hazards models. The American Thyroid Association (ATA) risk stratification system was integrated with the AJCC/UICC staging system for further investigation. Receiver operating characteristic (ROC) curves, Harrell's C-index, Akaike information criterion (AIC), and the Bayesian information criterion (BIC) were used to assess the models' performances. Results: Revised TNM categories, age cutoff, and clinical staging in the 8th edition resulted in reclassification of the overall stage. Applying the 8th edition, 1,278 stage III and 425 stage IV patients were reclassified as stage I; 950 stage III and 459 stage IV patients were reclassified as stage II; 77 stage IV patients were reclassified as stage III; and only 88 patients remained in stage IV. All patients in stage I, according to the 7th edition, remained in this stage when using the 8th edition. Patients classified into higher stages (III and IV) in the 8th edition showed a worse prognosis than those classified into same stages in the 7th edition. The 8th edition proved to be a better model with higher prognostic efficacy survival (higher AUC and C-index, lower AIC and BIC) than the 7th edition. When integrated with the ATA risk stratification system, the 8th edition still showed better discriminative power for patients in the higher risk group. Conclusion: Based on the SEER database, the 8th edition of the AJCC/UICC staging system has better prognostic efficacy than the 7th edition for patients with PTMC and FVPTMC.

Project description:Importance:Previous studies have shown that the AJCC Cancer Staging Manual, 7th edition (AJCC 7), tumor classification for cutaneous squamous cell carcinoma (CSCC) failed to accurately stratify disease-related outcomes. The recently released 8th edition (AJCC 8) features a revised tumor classification for only head and neck CSCC (HNCSCC). Objective:To compare AJCC 7 and AJCC 8 tumor classifications for HNCSCC and to validate AJCC 8. Design, Setting, and Participants:This was a 10-year retrospective cohort study (2000-2009) at an academic tertiary care center reviewing 680 primary HNCSCC tumors in 459 patients. Main Outcomes and Measures:Primary HNCSCC tumors were reviewed for disease-related outcomes (DROs): local recurrence (LR), nodal metastasis (NM), and disease-specific death (DSD). Tumors were stratified by AJCC 7 and AJCC 8 tumor classification. Distinctiveness (outcome differences between categories), homogeneity (outcome similarity within categories), and monotonicity (outcome worsening with increasing categories) were assessed for both classifications. Results:Most of the 459 patients were white (451 [98.3%]) and male (312 [68.0%]). AJCC 8 high tumor categories (T3/T4) accounted for 121 (17.8%) of total cases but 50 of 71 DROs (70.4%) (22 of 34 of LRs [64.7%], 17 of 24 NMs [70.8%], and 11 of 13 of DSDs [84.6%]). This was a significant improvement over AJCC 7, where only 12 of 71 DROs (16.9%) (4 of 34 LRs [11.8%], 3 of 24 NMs [12.5%], and 5 of 13 DSDs [38.5%]) occurred in T3/T4 categories. However, AJCC 8 T2 and T3 were indistinct, with overlapping 95% CIs for 10-year cumulative incidences of LR, NM, and DSD. The 10-year cumulative incidence of DROs in the 119 AJCC 8 T3 cases were 19.7% (95% CI, 13.0%-29.7%) for LR, 14.1% (95% CI, 9.7%-20.7%) for NM, and 9.3% (95% CI, 6.8%-14.0% for DSD). Conclusions and Relevance:AJCC 8 demonstrates superior homogeneity and monotonicity compared with AJCC 7. It now may be possible for AJCC 8 HNCSCC T2, T3, and T4 cases to be recorded and tracked by tumor registries because they represented a 23.1% subset in this study, which includes nearly all poor outcomes (85.9%). Further work is needed to validate AJCC 8 with population-level data and to compare AJCC 8 performance against alternative tumor classifications.

Dataset Information

Comparative study of the 7th and 8th AJCC editions for gastric cancer patients after curative surgery.

Objectives

Methods

Results

Conclusions

Publications

Comparative study of the 7th and 8th AJCC editions for gastric cancer patients after curative surgery.

Similar Datasets

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