Impact of clinical tumor–node–metastasis staging on survival in gastric carcinoma patients receiving surgery

Abstract

Background Preoperative clinical staging of gastric cancer is used to determine therapeutic strategies. However, the impact of the clinical stage on survival has not been completely investigated, although the relationship between pathologic staging and survival outcome has been reported. The aim of the present study was to clarify the predictability of patient survival based on clinical staging and to evaluate the usefulness of staging as an indicator for selecting the treatment modality. Methods A total of 3033 patients who underwent surgery for gastric cancer were included. A survival analysis was conducted based on the seventh edition of the tumor-nodemetastasis (TNM) clinical staging system of the American Joint Committee on Cancer. The predictive ability of the TNM clinical stage for survival was evaluated by Harrell's C-index, a measure of the separation of survival distributions.Results The cumulative 5-year survival rates according to the clinical stage were 94.3 % (IA), 84.7 % (IB), 71.7 % (IIA), 56.1 % (IIB), 55.7 % (IIIA), 42.3 % (IIIB), 22.8 % (IIIC), and 9.1 % (IV). Although no significant difference was observed between clinical stages IIB and IIIA (p = 0.865), significant differences existed between all other clinical stages (p \ 0.001). Harrell's C-index applied to these results was 0.825 (95 % confidence interval 0.819-0.831). Conclusions The seventh edition of the TNM clinical staging system has a strong prognostic ability with a satisfactory C-index and should be considered valuable for selecting therapeutic strategies for the treatment of gastric cancer.

Validation of the prognostic impact of the new tumor-node-metastasis clinical staging in patients with gastric cancer

“…We have previously published the prognostic impact of clinical staging of gastric cancer based on the 7th TNM [12]. Also in this study, our results showed the excellent prognostic impact of the cStage proposed in the 8th edition of the TNM classification.…”

“…The preoperative invasion depth (cT), lymph node metastasis (cN), and distant metastasis (cM) were determined in accordance with a previously published report [12]. A brief summary is presented below.…”

“…Given that an increasing number of gastric cancer patients are treated by neoadjuvant chemotherapy (NAC) especially in the Western countries [5,6], the 8th edition declared that, in addition to the pStages, a clinical stage classification (cStages) be established based on evidence acquired before treatment so that the a broad range of treatment strategies including preoperative therapies can be selected and evaluated. However, reports on the correlation between TNM classification and survival have been mostly based on the pStages obtained after surgery [7][8][9][10], and only a few attempts to evaluate clinical staging prior to surgery had been made [11,12]. The AJCC Cancer Staging Manual [1] provides survival curves that were used as a basis of the cStage in the 8th edition, but does not provide detailed data for the cT or cN categories.…”

The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging

“…The AJCC eighth edition also provides an alternative clinical stage prognostic table derived from surgically treated patients treated at Shizouoka Cancer Center (Japan) [14,15]. The use of two data sources provided validation for our clinical stage grouping schema with excellent separation of stage groups from both sources while highlighting differences in prognosis based on clinical stage derived from all patients or only surgical patients and by differences in the patient population (US versus Japanese patients).…”

Expression of ERO1L in gastric cancer and its association with patient prognosis

“…There were 46 cases in the gastric antrum/pylorus, 36 cases in gastric fundus/cardia and 23 cases in the gastric body. Additionally, the tumor-node-metastasis (TNM) stages of all patients were assessed (13). There were 46 patients with TNM stage II and 59 patients had stage III.…”