Division of Gastric Surgery, Shizuoka Cancer Center, Shimonagakubo 1007, Nagaizumichou, Suntougun, Shizuoka, 411-0934, Japan.
Gastric Cancer. 2019 Jan;22(1):123-129. doi: 10.1007/s10120-018-0799-9. Epub 2018 Jan 22.
In the 8th edition of the tumor-node-metastasis (TNM) classification, the gastric cancer staging system includes two classifications: the clinical stage (cStage) and the postoperative pathologic stage. However, the correlation between the new cStage and overall survival has not been studied. Moreover, clinical N (cN) grade analysis is not included in the new clinical staging system. This study validated the prognostic value of cStage in the 8th edition of the TNM classification and the significance of N classification for pretreatment staging in gastric cancer.
A total of 4374 patients with primary gastric cancer who underwent surgery at the Shizuoka Cancer Center were included. Survival analysis was conducted based on the newly proposed cStage criteria of the TNM 8th edition. Prognostic accuracy was evaluated using Harrell's concordance index (C-index).
The five-year survival rates according to cStage were as follows: cStageI, 91.2%, cStageIIA: 75.1%, cStageIIB: 57.7%, cStageIII: 43.2%, cStageIVA: 31.6%, and cStageIVB: 7.7%. Significant differences were observed among all stages (P < 0.001). The cStage C-index was 0.802. Meanwhile, the five-year survival rates based on cN were as follows: cN0: 83.7%, cN1: 57.2%, cN2: 42.4%, cN3a: 22.1%, and cN3b: 0.0%. Significant differences were also observed among all cN grades (P < 0.001).
The cStage of the 8th edition of the TNM classification has a good capability to predict prognosis; thus, it may be a useful indicator for selecting appropriate gastric cancer treatment modalities. In addition, cN can be included in developing a more precise clinical staging of gastric cancer.
在第八版肿瘤-淋巴结-转移（TNM）分类中，胃癌分期系统包括两种分类：临床分期（cStage）和术后病理分期。然而，新的 cStage 与总生存之间的相关性尚未得到研究。此外，新的临床分期系统中不包括临床 N（cN）分级分析。本研究验证了第八版 TNM 分类中 cStage 的预后价值，以及 N 分级在胃癌术前分期中的意义。
共纳入在静冈癌症中心接受手术治疗的 4374 例原发性胃癌患者。根据 TNM 8 版新提出的 cStage 标准进行生存分析。预后准确性通过 Harrell 一致性指数（C-index）进行评估。
根据 cStage 的五年生存率如下：cStageI：91.2%，cStageIIA：75.1%，cStageIIB：57.7%，cStageIII：43.2%，cStageIVA：31.6%，cStageIVB：7.7%。所有分期之间差异均有统计学意义（P<0.001）。cStage 的 C-index 为 0.802。同时，根据 cN 的五年生存率如下：cN0：83.7%，cN1：57.2%，cN2：42.4%，cN3a：22.1%，cN3b：0.0%。所有 cN 分级之间差异均有统计学意义（P<0.001）。
第八版 TNM 分类的 cStage 具有良好的预测预后能力；因此，它可能是选择合适胃癌治疗方式的有用指标。此外，cN 可用于制定更精确的胃癌临床分期。
