Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, Fujian Province, China; Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, Fujian Province, China.
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian Province, China.
Eur J Surg Oncol. 2018 Aug;44(8):1205-1211. doi: 10.1016/j.ejso.2018.05.014. Epub 2018 May 17.
Our aim was to evaluate the prognostic performance of the 8th edition AJCC staging system for gastric cancer survival after 10 years or more.
An international multicenter database was constructed (total n = 4537) by combining gastric cancer cases from the SEER database (n = 3066) and the database (n = 1471) of the Department of Gastric Surgery, Fujian Medical University Union Hospital. The relative discriminatory abilities were assessed using the likelihood ratio chi-square test, Akaike's Information Criterion (AIC) and Harrell's concordance index (c-statistic).
The 10-year overall survival rate for all the patients was 32.2%. A 2-step multivariate analysis showed that the 8th edition staging system was an independent factor for long-term overall survival. It also had higher likelihood ratio chi-square score, c-statistic and smaller AIC values compared with the 7th edition. However, stages IB and IIA of the TNM staging system showed a similar prognosis (both P > 0.05). Based on the survival data, we revised the 8th edition by merging stages IB and IIA into 1 category in the training set. The modified staging system demonstrated superior prognostic stratification with a higher c-statistic, likelihood ratio chi-square score and smaller AIC values compared to the 8th edition. Similar results were observed in the external validation set.
The 8th edition AJCC TNM classification predicts the 10-year survival of gastric cancer patients more accurately than the 7th edition. However, by merging stages IB and IIA into 1 category, we propose a revised TNM stage system that provides an optimal prognosis.
本研究旨在评估第 8 版 AJCC 胃癌分期系统在 10 年及以上生存预后中的预测效能。
本研究通过合并 SEER 数据库（n=3066）和福建医科大学附属协和医院胃外科数据库（n=1471）中胃癌病例，构建了一个国际多中心数据库。通过似然比卡方检验、Akaike 信息准则（AIC）和 Harrell 一致性指数（c 统计量）评估相对判别能力。
所有患者的 10 年总生存率为 32.2%。两步多因素分析显示，第 8 版分期系统是长期总生存的独立因素。与第 7 版相比，其似然比卡方得分、c 统计量更高，AIC 值更小。然而，TNM 分期系统的 IB 期和 IIA 期具有相似的预后（均 P>0.05）。基于生存数据，我们在训练集中将第 8 版的 IB 期和 IIA 期合并为 1 个类别进行修订。与第 8 版相比，修订后的分期系统具有更高的 c 统计量、似然比卡方得分和更小的 AIC 值，具有更好的预后分层能力。在外部验证集中也观察到了类似的结果。
第 8 版 AJCC TNM 分类比第 7 版更能准确预测胃癌患者的 10 年生存率。然而，通过将 IB 期和 IIA 期合并为 1 个类别，我们提出了一种新的 TNM 分期系统，可提供更优的预后。
