Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database

In, Haejin; Solsky, Ian; Palis, Bryan E.; Langdon-Embry, Marisa; Ajani, Jaffer A.; Sano, Takeshi

doi:10.1245/s10434-017-6078-x

Cited by 276 publications

(229 citation statements)

References 20 publications

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“…All patients underwent an adjuvant chemotherapy regimen with S-1 at our institute. Tumor stages were assessed according to the Union for International Cancer Control classification 35 .…”

Section: Methodsmentioning

confidence: 99%

“…All patients underwent an adjuvant chemotherapy regimen with S-1 at our institute. Tumor stages were assessed according to the Union for International Cancer Control classification 35 .Peripheral blood (7 ml) was obtained from each patient before surgery. The blood was transferred into sodium heparin tubes (BD Vacutainer, Franklin Lakes, NJ) and immediately subjected to a three-spin protocol (1500 r.p.m.…”

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confidence: 99%

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Plasma microRNA profiles: identification of miR-1229-3p as a novel chemoresistant and prognostic biomarker in gastric cancer

Nishibeppu

Komatsu

Imamura

et al. 2020

Sci Rep

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This study aimed to explore novel microRNAs in plasma for predicting chemoresistance in adjuvant chemotherapy for patients with gastric cancer (GC). We used the Toray 3D-Gene microRNA arraybased approach to compare preoperative plasma microRNA levels between GC patients with and without recurrences after curative gastrectomy. All patients underwent adjuvant chemotherapy with S-1, an oral fluoropyrimidine. Of 2566 candidates, six candidate microRNAs (miR-1229-3p, 1249-5p, 762, 711, 1268a and 1260b), which were highly expressed in the preoperative plasma of patients with subsequent recurrences, were selected. In a large-scale validation analysis by quantitative RT-PCR, we focused on high plasma levels of miR-1229-3p, which was an independent poor prognostic factor for recurrence free survival (P = 0.009, HR = 3.71). Overexpression of miR-1229-3p in GC cells induced significant chemoresistance to 5-fluorouracil (5-FU), up-regulation of thymidylate synthase (TS) and dihydroprimidine dehydrogenase (DPD) and down-regulation of SLC22A7 both in vitro and in vivo. Intraperitoneal injection of miR-1229-3p in mice induced significant chemoresistance to 5-FU, accompanied by high levels of miR-1229-3p in plasma and tumor tissue. These findings suggest that plasma miR-1229-3p might be a clinically useful biomarker for predicting chemoresistance to S-1 and selecting other or combined intensive chemotherapy regimens in GC patients.Gastric cancer (GC) is the third leading cause of cancer-related death both in Japan and worldwide. Although the surgical techniques, perioperative chemotherapy regimens and perioperative management have greatly improved, GC remains one of the most common cancer types and constitutes a global health problem 1,2 . Curative gastrectomy with lymphadenectomy is recognized as an opportunity for macroscopic tumor clearance and a cure for GC. However, the effect of surgical resection is restricted to local control of the primary tumor 3,4 ; thereby, it cannot prevent recurrence due to micrometastasis. Therefore, perioperative chemotherapy has been recommended to achieve microscopic tumor clearance in advanced GC. In Japan, an adjuvant chemotherapy regimen with S-1, an oral fluoropyrimidine, following curative gastrectomy for Stage II or III GC is recommended as a standard treatment to improve the survival rate of GC patients, based on the results of the ACTS-GC (Adjuvant Chemotherapy Trial of TS-1 for Gastric Cancer) 5,6 . However, some GC patients after curative gastrectomy followed by adjuvant S-1 chemotherapy had recurrences 7 . Nevertheless, no companion diagnostic marker has been detected for predicting chemoresistance to 5-fluorouracil (5-FU) or the oral modulated 5-FU prodrug S-1 in GC.MicroRNAs (miRNAs), which are small noncoding RNAs, modulate the translation of specific protein-coding genes. miRNA was discovered in 1993, and a lot of studies have identified alterations in miRNA expression that contribute to the progression of various diseases, including the progression and development of several can...

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“…All patients underwent an adjuvant chemotherapy regimen with S-1 at our institute. Tumor stages were assessed according to the Union for International Cancer Control classification 35 .…”

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Plasma microRNA profiles: identification of miR-1229-3p as a novel chemoresistant and prognostic biomarker in gastric cancer

Nishibeppu

Komatsu

Imamura

et al. 2020

Sci Rep

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“…Although the TNM 8th edition proved to be superior to the TNM 7th edition in predicting overall survival, [4][5][6][7] both editions are subject to the risk of stage migration. The phenomenon of stage migration occurs when the number of examined lymph nodes is insufficient.…”

Section: Introductionmentioning

confidence: 98%

“…For this reason, the prognostic accuracy of the node subsection (N) of the American Joint Committee on Cancer (AJCC) tumor‐node‐metastasis (TNM) classification has been pursued in all its late editions. Although the TNM 8th edition proved to be superior to the TNM 7th edition in predicting overall survival, both editions are subject to the risk of stage migration. The phenomenon of stage migration occurs when the number of examined lymph nodes is insufficient.…”

Section: Introductionmentioning

confidence: 99%

Ratio‐based staging systems are better than the 7th and 8th editions of the TNM in stratifying the prognosis of gastric cancer patients: A multicenter retrospective study

Agnes

Biondi

Cananzi

et al. 2019

Journal of Surgical Oncology

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Background The current and the previous editions of the tumor‐node‐metastasis (TNM) system for gastric cancer (GC; TNM8 and TNM7) have a high risk of stage‐migration bias when the node count after gastrectomy is suboptimal. Hence, they are possibly not the optimal staging systems for GC patients. This study aims to compare the TNM with two systems less affected by the stage‐migration bias, namely, the lymph nodes ratio (LNR) and the log odds of positive lymph nodes (LODDS), to assess which one is the best in stratifying the prognosis of GC patients. Methods The sample study included 1221 GC patients. Two 7‐cluster staging systems based on the combination of pT categories and LNR and LODDS categories (TLNR and TLODDS) were compared with the two last editions of TNM, using the Akaike information criteria, the Bayesian information criteria, and the receiver operating characteristic (ROC) curve graphs. Further validation on an independent sample of 251 patients was carried out. Results The univariable and multivariable analyses and the ROC curves detected an advantage of the TLNR and TLODDS systems over the TNM. The TLNR and TLODDS showed the best accuracy both in the subgroup of patients with ≥16 nodes examined. The results were confirmed in the validation analysis. Conclusions TLNR and TLODDS staging systems should be considered a valid implementation of the TNM for the prognostic stratification of GC patients. If these results are confirmed in further studies, the future implementation of the TNM should consider the introduction of the LNR or the LODDS along with the number of metastatic nodes.

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“…The 8th edition (8th) of the AJCC staging system was released in October 2016 and was recommended as a replacement for the older version in 2018 [1]. Research on the prognostic performance of the latest version has been gradually reported [2][3][4][5][6]. In our opinion, the 8th AJCC-TNM staging system can better distinguish the prognosis of GC patients.…”

Section: Introductionmentioning

confidence: 99%

A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system

et al. 2019

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Background The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). Methods The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. Results nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. Conclusion Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Validation of the 8th Edition of the AJCC TNM Staging System for Gastric Cancer using the National Cancer Database

Abstract: The 8th edition is valid for U.S. populations, showing clear separation of data with preservation of group order.

Cited by 276 publications

References 20 publications

Plasma microRNA profiles: identification of miR-1229-3p as a novel chemoresistant and prognostic biomarker in gastric cancer

Plasma microRNA profiles: identification of miR-1229-3p as a novel chemoresistant and prognostic biomarker in gastric cancer

Ratio‐based staging systems are better than the 7th and 8th editions of the TNM in stratifying the prognosis of gastric cancer patients: A multicenter retrospective study

A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system

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