Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project.
Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project.
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DOI：
10.1007/s10120-016-0601-9
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Ohashi Y
中科院分区：
文献类型：
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作者：
Sano T;Coit DG;Kim HH;Roviello F;Kassab P;Wittekind C;Yamamoto Y;Ohashi Y
目前的 AJCC 胃癌分期系统 (AJCC7) 对前一版本进行了多项重大修订。重新定义了 T 和 N 类别以及分期组，并根据食管系统对食管胃结合部 (EGJ) 腺癌进行了重新分类和分期。验证这些变化的研究显示出不一致的结果。国际胃癌协会 (IGCA) 启动了一个项目，支持对下一版 AJCC 分期系统进行循证修订。回顾性收集2000年至2004年间在15个国家59家机构接受根治性胃切除术的患者的临床和病理资料。手术后五年内失访的患者被排除在外。接受新辅助治疗的患者被排除在外。对数据进行总体分析，并按治疗区域分别进行分析。在25,411个符合条件的案例中，84.8%来自日本和韩国的24个机构，6.4%来自亚洲其他国家，8.8%来自29个西方机构。 AJCC7 的 T 和 N 类别清楚地对患者生存进行了分层。 pN3a 和 pN3b 患者在所有区域均表现出不同的预后，通过将 pN3a 和 pN3b 引入聚类分析，我们建立了一个新的分期分组，其分层效果比 AJCC7 更好，尤其是在 III 期亚组中。 Siewert 2 型和 3 型 EGJ 肿瘤的存活率通过该 IGCA 分期分组比通过 AJCC7 的食管或胃方案更好地分层。对于 AJCC 分类的下一次修订，我们提出了基于大量全球数据收集的新阶段分组。
The current AJCC staging system for gastric cancer (AJCC7) incorporated several major revisions to the previous edition. The T and N categories and the stage groups were newly defined, and adenocarcinoma of the esophagogastric junction (EGJ) was reclassified and staged according to the esophageal system. Studies to validate these changes showed inconsistent results. The International Gastric Cancer Association (IGCA) launched a project to support evidence-based revisions to the next edition of the AJCC staging system. Clinical and pathological data on patients who underwent curative gastrectomy at 59 institutions in 15 countries between 2000 and 2004 were retrospectively collected. Patients lost to follow-up within five years of surgery were excluded. Patients treated with neoadjuvant therapy were excluded. The data were analyzed in total, and separately by region of treatment. Of 25,411 eligible cases, 84.8% were submitted from 24 institutions of Japan and Korea, 6.4% from other Asian countries, and 8.8% from 29 Western institutions. The T and N categories of AJCC7 clearly stratified the patient survival. Patients with pN3a and pN3b showed distinct prognosis in all regions, and by introducing pN3a and pN3b into a cluster analysis, we established a new stage grouping with better stratification than AJCC7, especially among stage III subgroups. Survival of Siewert type 2 and 3 EGJ tumors was better stratified by this IGCA stage grouping than by either esophageal or gastric scheme of AJCC7. For the next revision of AJCC classification, we propose a new stage grouping based on a large, worldwide data collection.