Cancer Res Treat.  2019 Jul;51(3):876-885. 10.4143/crt.2018.401.

Comparison of the 7th and the 8th AJCC Staging System for Non-metastatic D2-Resected Lymph Node–Positive Gastric Cancer Treated with Different Adjuvant Protocols

• Yu JI
• Lim DH
• Lee J
• Kang WK
• Park SH
• Park JO
• Park YS
• Lim HY
• Kim ST
• Lee SJ
• Kim S
• Sohn TS
• Lee JH
• An JY
• Choi MG
• Bae JM
• Yoo H
• Kim K

• KMID: 2454280
• DOI: http://doi.org/10.4143/crt.2018.401

Abstract

PURPOSE
The purpose of this study was to compare prognostic differentiation performances of the 7th and the 8th edition of American Joint Committee on Cancer (AJCC) staging system for gastric cancer (GC) patients.
MATERIALS AND METHODS
A total of 1,633 GC patients who underwent curative D2 resection followed by adjuvant chemotherapy alone (CA) or concurrent chemo-radiotherapy (CCRT) from 2004 to 2013 were included. Concordance index (c-index) was applied to compare the discriminatory ability.
RESULTS
In the 8th edition, migration of stage was detected in 248 patients (15.2%). Among them, 121 patients were up-staged while 127 patients were down-staged. Overall, there was no statistically significant difference in the discriminatory ability between the 7th and 8th editions. The new edition of staging system, however, showed a trend of better prognostic performance not only in recurrence-free survival (c-index=0.734; 95% confidence interval [CI], 0.706 to 0.762 in the 7th edition vs. c-index=0.740; 95% CI, 0.712 to 0.768 in the 8th edition; p=0.14), but also in overall survival (c-index=0.717; 95% CI, 0.688 to 0.745 in the 7th edition vs. c-index=0.722; 95% CI, 0.694 to 0.751 in the 8th edition; p=0.19), especially in stage III. This finding was repeated in the subgroup analysis regardless of adjuvant CA or CCRT.
CONCLUSION
Generally, the 8th edition of AJCC staging system had failed to show a superior discriminatory ability for curatively D2 resected GC patients than the 7th edition, although there was a trend of better prognostic performance of the new edition, regardless of adjuvant treatment method.

Keyword

Stomach neoplasms; Radiotherapy; Neoplasm staging; Recurrence; Prognosis

MeSH Terms

Chemotherapy, Adjuvant
Humans
Joints
Methods
Neoplasm Staging
Prognosis
Radiotherapy
Recurrence
Stomach Neoplasms*

Figure

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  Fig. 1. The number of patients redistributed in the 8th edition from the 7th edition of the American Joint Committee on Cancer (AJCC) staging system for gastric cancer is displayed. The solid line indicates upstaging while the dot line indicates downstaging.

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  Fig. 2. Kaplan-Meier curves of recurrence-free survival according to the 7th versus the 8th edition of American Joint Committee on Cancer staging system. More clear discrimination of survival curves between stage IIIA to IIIC is shown in the 8th edition than that in the 7th edition for all (7th edition in A vs. 8th edition in B), CA (7th edition in C vs. 8th edition in D), and concurrent chemo-radiotherapy (7th edition in E vs. 8th edition in F) patients.

• 

  Fig. 3. Kaplan-Meier curves of overall survival according to the 7th versus the 8th edition of American Joint Committee on Cancer staging system. More clear discrimination of survival curves for stages IIIA to IIIC was shown in the 8th edition than that in the 7th edition for all (7th edition in A vs. 8th edition in B), chemotherapy alone (7th edition in C vs. 8th edition in D), and concurrent chemo-radiotherapy (7th edition in E vs. 8th edition in F) patients.

Reference

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