Staging of gastric cancer with the Clinical Stage Prediction score

Abstract

Background Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. Accordingly, it is important to distinguish between stage III/IV and stage I/II gastric cancer, but clinical staging is less accurate than pathological staging. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer. Methods We reviewed 2722 patients who underwent gastrectomy at our hospital from January 1996 to December 2015. As pretreatment factors potentially related to tumor stage, we assessed age, sex, tumor markers, tumor diameter, tumor location, tumor histology, and macroscopic type. Factors showing significance on multivariate analysis were used to develop the Clinical Stage Prediction score (CSP score), and a cutoff value for the score was determined by receiver operating characteristics analysis. Results According to multivariate analysis, clinical factors associated with stage III/IV disease were elevation of the carcinoembryonic antigen level, tumor diameter ≥ 60 mm, circumferential gastric involvement, esophageal infiltration, mucinous adenocarcinoma, and macroscopic types 2–4. The CSP score was obtained by weighting these factors according to the non-standardized β-coefficient. Receiver operating characteristics analysis indicated that the optimum cutoff value of the CSP score was 17 points. Among 1042 patients with a CSP score ≥ 17 points, 820 patients (78.7%) had stage III/IV gastric cancer. Conversely, among 1680 patients with a CSP score < 17 points, 1547 patients (92.1%) had stage I/II gastric cancer. When discrimination of stage III/IV gastric cancer from stage I/II gastric cancer by the CSP score was assessed, the sensitivity was 78.7%, specificity was 92.1%, positive predictive value was 86.0%, and negative predictive value was 87.5%. Conclusions The CSP score can be helpful for differentiating stage III/IV gastric cancer from stage I/II gastric cancer based on pretreatment clinical factors.

Development and external validation of a prognostic nomogram for patients with gastric cancer after radical gastrectomy

“…We hope the prognostic risk stratification nomogram can provide guidance for clinical practice and help facilitate tailored decision-making, thus avoiding overtreatment or undertreatment in GC patients and improving communication between clinicians and patients. At present, the most commonly accepted prognostic risk prediction system in clinical practice is TNM staging, but the accuracy and stability it offers are limited, and thus its value in precision medicine has increasingly declined (34)(35)(36)(37). Several studies of prognostic nomograms have emphasized their potential advantages to patients and a reliable risk-based predictive tool that can be used widely in cancer-related research (38).…”

Negative Lymph Node Is an Independent Prognostic Factor for Stage III Gastric Cancer Patients After Curative Gastrectomy: A Surveillance, Epidemiology, and End Results-Based Study

“…5,6 The mortality of patients diagnosed with GC is related strongly to their stage of disease. 7 The most used staging system for GC is the American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) system. Among them, the N stage was one of the most powerful prognostic factors.…”

Interpretable semisupervised classifier for predicting cancer stages

“…), like the prostrate pathological stage predictor based on biopsy patterns, PSA (Prostate-Specific Antigen) level and other clinical factors (Cosma et al, 2016). In similar terms, there are staging predictors available for breast and colon cancer based on clinical factors (Said et al, 2018;Taniguchi et al, 2019). There are more than 200 types of cancer developing from different types of cells in the body, lung cancer being the most common (11.6% of total cases, 18.4% of total cancer-related deaths), followed by breast cancer, colorectal and prostate cancer (Bray et al, 2018;"Cancer," 2018).…”