Equipping the 8th Edition American Joint Committee on Cancer Staging for Gastric Cancer with the 15-Node Minimum: a Population-Based Study Using Recursive Partitioning AnalysisReport as inadecuate




Equipping the 8th Edition American Joint Committee on Cancer Staging for Gastric Cancer with the 15-Node Minimum: a Population-Based Study Using Recursive Partitioning Analysis - Download this document for free, or read online. Document in PDF available to download.

Journal of Gastrointestinal Surgery

pp 1–8

First Online: 27 July 2017Received: 26 April 2017Accepted: 10 July 2017

Abstract

BakcgroundThe recently proposed 8th American Joint Committee on Cancer AJCC staging for gastric cancer GC did not include the evaluated lymph node ELN count as a prognostic indicator. In this study, we performed recursive partitioning analysis RPA to objectively combine the 15-ELN threshold and 8th AJCC stage to refine the staging for GC.

MethodsWe analyzed 19,018 patients with non-metastatic GC from the Surveillance, Epidemiology, and End Results database. The dataset was randomly divided into training and validation sets.

ResultsFor each 8th AJCC stage, survival was significantly better for patients with ≥15 ELNs versus those with <15 ELNs P < 0.001 for all. RPA divided non-metastatic GC into seven stages: RPA-IA 8th AJCC IA with ≥15 ELNs, RPA-IB IA with <15 ELNs and IB-IIA with ≥15 ELNs, RPA-IIA IB with <15 ELNs and IIB with ≥15 ELNs, RPA-IIB IIA with <15 ELNs and IIIA with ≥15 ELNs, RPA-IIIA IIB with <15 ELNs, RPA-IIIB IIIA with <15 ELNs and IIIB ≥15 ELNs, and RPA-IIIC IIIB with <15 ELNs and IIIC. The corresponding 5-year survival rates were 84.1, 70.3, 52.8, 41.4, 32.9, 21.7, and 10.2%, respectively P < 0.001 for all pairwise comparisons. The RPA staging outperformed the 8th AJCC staging in terms of discrimination and homogeneity among the SEER training and validation sets, as well as an independent Chinese cohort.

ConclusionBy equipping the 8th AJCC stage with the 15-ELN threshold, the proposed RPA staging is superior to the 8th AJCC staging without overcomplicating.

KeywordsGastric cancer American Joint Committee on Cancer staging Evaluated lymph node Recursive partitioning analysis Surveillance, Epidemiology, and End Results Shu-Qiang Yuan and Yu-Tong Chen have contributed equally as first authors.

Electronic supplementary materialThe online version of this article doi:10.1007-s11605-017-3504-0 contains supplementary material, which is available to authorized users.

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Author: Shu-Qiang Yuan - Yu-Tong Chen - Ze-Ping Huang

Source: https://link.springer.com/







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