Ye Jinning, Ren Yufeng, Wei Zhewei, Hou Xun, Dai Weigang, Cai Shirong, Tan Min, He Yulong, Yuan Yujie
Center of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, PR China; Center of Gastric Cancer, Sun Yat-Sen University, PR China.
Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, PR China.
Surg Oncol. 2018 Jun;27(2):146-153. doi: 10.1016/j.suronc.2018.02.009. Epub 2018 Feb 27.
The 8th edition of AJCC TNM staging manual for gastric cancer (GC) has been validated by several studies. A modified staging system based on it and total harvested number of lymph nodes (LNs; cutoff: 30) is suggested to improve predictive capacities for advanced GC. This study is designed to validate the modified method using a single-center database in Southern China.
Clinical data from 684 GC patients with stage II and III according to the 7th edition between 2001 and 2012 were reviewed. A modified staging system was applied to restage the cohort. The three staging systems were compared in terms of prognostic performance on long-term survival.
The median follow-up period of this cohort was 52 (range, 6-180) months, with a median 5-year overall survival rate of 52.4%. Stage migration was observed in 159 (23.2%) patients according to the 8th edition of TNM staging, and another migration was observed in 108 (15.8%) patients according to the modified TNM staging system. Compared with the modified staging system, both 7th and 8th edition of AJCC TNM staging systems did not prove survival concordance on stage IIIA (7th edition) and stage IIIC (8th edition) when <30 LNs were examined. The survival performance between two AJCC staging systems had no significant improvement (c-index, 0.607 vs. 0.609), with the best prognostic stratification obtained using the modified staging method (c-index, 0.631).
The modified staging system on basis of the 8th AJCC classification and the number of harvested LNs could provide an optimal predictive capacities for advanced gastric cancer.
美国癌症联合委员会（AJCC）胃癌TNM分期手册第8版已通过多项研究验证。有人建议基于该版分期手册并结合总的淋巴结（LN）清扫数目（临界值：30）修改分期系统，以提高对进展期胃癌的预测能力。本研究旨在利用中国南方一个单中心数据库对修改后的方法进行验证。
回顾2001年至2012年间根据第7版分期为II期和III期的684例胃癌患者的临床资料。应用修改后的分期系统对该队列进行重新分期。比较三种分期系统对长期生存的预后表现。
该队列的中位随访期为52（范围6 - 180）个月，中位5年总生存率为52.4%。根据第8版TNM分期，159例（23.2%）患者出现分期迁移，根据修改后的TNM分期系统，另有108例（15.8%）患者出现分期迁移。与修改后的分期系统相比，当检查的LN数目<30时，AJCC TNM分期系统的第7版和第8版在IIIA期（第7版）和IIIC期（第8版）均未显示生存一致性。两个AJCC分期系统之间的生存表现没有显著改善（c指数，0.607对0.609），使用修改后的分期方法获得了最佳的预后分层（c指数，0.631）。
基于第8版AJCC分类和清扫的LN数目的修改后的分期系统可为进展期胃癌提供最佳预测能力。
