Multi-institutional validation of the 8th AJCC TNM staging system for gastric cancer: Analysis of survival data from high-volume Eastern centers and the SEER database
Multi-institutional validation of the 8th AJCC TNM staging system for gastric cancer: Analysis of survival data from high-volume Eastern centers and the SEER database
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DOI：
10.1002/jso.25639
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发表时间：
2019-07-23
影响因子：
2.5
通讯作者：
Hyung, Woo Jin
中科院分区：
文献类型：
--
作者：
Son, Taeil;Sun, Jiyu;Hyung, Woo Jin
第8届美国癌症联合委员会TNM胃癌分期系统与第7版的临床相关性和普遍适用性尚未使用来自东西方的数据集进行检查。方法回顾性分析韩国两个大容量中心（Severance医院[SH]和Gangnam Severance医院[GSH]）治疗的胃腺癌患者（n = 29 984）和来自监测、流行病学和最终结果（SEER）数据库的数据。比较生存曲线、肿瘤分期的表现和改良亚组的同质性。结果IIB期亚组变化较小，III期变化最大。根据对数秩检验、C指数和AIC（分别为8444.5 vs 9263.8、0.796 vs 0.798和104152 vs 103909），对于SH数据，应用第8分期系统比应用第7版更有利于生存预测。它的表现也是上级的GSH和SEER数据。在SH、GSH和SEER数据的IIB至IIIC期亚组分析中，第8分期系统显示每个亚分类的生存率与第7版本相似或更均匀。结论与第7代胃癌分期系统相比，新版胃癌分期系统对预后的预测更准确，亚组划分更均匀。
Background The clinical relevance and general applicability of the 8th American Joint Committee on Cancer TNM gastric cancer staging system vs the 7th version have not been examined using datasets from both the East and West. Methods Patients (n = 29 984) treated for gastric adenocarcinoma at two high-volume centers (Severance Hospital [SH] and Gangnam Severance Hospital [GSH]) in Korea and data from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed. Survival curves, the performance of tumor staging, and the homogeneity of modified subgroups were compared. Results Minute changes were noted in the stage IIB subgroup; most changes were noted in stage III. Applying the 8th staging system facilitated better prediction of survival than applying the 7th version for SH data according to the log-rank test, C-index, and AIC (8444.5 vs 9263.8, 0.796 vs 0.798, and 104152 vs 103909, respectively). Its performance was also superior for GSH and SEER data. In a subgroup analysis of stages IIB to IIIC in SH, GSH, and SEER data, the 8th staging system showed similar or more homogeneous survival for each sub-classification than the 7th version. Conclusion Compared with the 7th gastric cancer staging system, the newer version more accurately predicted prognosis and stratified subgroups more homogeneously.