Development and validation of a new staging system for node‐negative gastric cancer based on recursive partitioning analysis: An international multi‐institutional study

Abstract

Background Whether the tumor‐node‐metastasis (TNM) staging system is appropriate for patients with node‐negative gastric cancer (GC) is still inconclusive. The modified staging system developed by recursive partitioning analysis (RPA) showed good prognostic performance in a variety of cancers. The application of RPA has not been reported in the prognostic prediction of GC. Methods Node‐negative GC patients who underwent radical resection at Fujian Medical University Union Hospital (n = 862) and Sun Yat‐sen University Cancer Center (n = 311) with at least 5 years of follow‐up were selected as the training set. RPA was used to develop a modified staging system. Patients from the Surveillance, Epidemiology, and End Results database (n = 1415) were selected as the validation set. Results The 5‐year overall survival (OS) rates of patients with 8th AJCC‐TNM stage IA‐IIIA in the training set were IA 95.2%, IB 87.1%, IIA 78.3%, IIB 75.8%, and IIIA 72.6%. Multivariate analysis (MVA) showed that larger tumor size, elder age, and deeper depth of invasion were independent predictors for OS in patients with node‐negative GC (all P < 0.05). Patients were reclassified into RPA I, RPA II, RPA III, and RPA IV stages based on RPA; the 5‐year OS rates were 96.1%, 87.2%, 81.0%, and 64.3%, respectively, with significant difference (P < 0.05). Two‐step MVA showed that the RPA staging system was an independent predictor of OS (P < 0.05). Compared with the 8th AJCC‐TNM staging system, the RPA staging system had a smaller AIC value (2544.9 vs 2576.2), higher χ2 score (104.2 vs 69.6) and higher Harrell's C‐index (0.697 vs 0.669, P = 0.007). The similar results were found in the validation set. Conclusions A new prognostic predictive system based on RPA was successfully developed and validated, which may be suggested for staging node‐negative GC in future.

Indications of neoadjuvant chemotherapy for locally advanced Gastric Cancer patients based on pre-treatment clinicalpathological and laboratory parameters

“…Recently, nomograms have been used for tumor prognosis prediction models after NAT [11][12][13][14][15][16]. These models show superior performance compared to conventional staging models [17][18][19][20][21]. Most studies analyzing prognosis of individuals who underwent treatment and follow-ups use nomograms.…”

Multicenter Validation Study of the American Joint Commission on Cancer (8th Edition) for Gastric Cancer: Proposal for a Simplified and Improved TNM Staging System

“…The placement of some pN3a patients was revised into stage IIIB, and pT3-4bN3bM0 was classified as stage IIIC [12]. Although previous studies have confirmed the prognostic value of the 8th AJCC stage system for gastric cancer (GC), it is mostly confined to patients with stage III [31], lymph node negative or lymph node the 15-Lymph Node Minimum [32,33]. Our study firstly evaluated the prognostic value of the 8th AJCC stage system for resectable GC from multicenter database.…”

Revisiting the 8th AJCC system for gastric cancer: A review on validations, nomograms, lymph nodes impact, and proposed modifications

“…Furthermore, Lin and colleagues conceptualized the application of recursive partition analysis in the prognostic prediction of node-negative gastric cancer. The tool produced superior outcomes than the AJCC [ 63 ]. A nomogram based on T stage, N stage, comprehensive treatment, age at diagnosis, grade, and tumor size performs better in the individualized prediction of survival among patients with resectable disease, including stage III/IV patients [ 64 ].…”