Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi-Institutional Study

The oncologist

article

Qing Zhong¹  Jun-Fang Hou³  Jian-Xian Lin¹  Jun Lu¹  Long-Long Cao¹  Mi Lin¹  Ru-Hong Tu¹  Ze-Ning Huang¹  Ju-Li Lin¹  Zhi-Yu Liu¹  Si-Jin Que¹  Qi-Yue Chen¹  Ping Li¹  Chao-Hui Zheng¹  Chang-Ming Huang¹  Amilcare Parisi⁴  Yu-Bin Ma³  Guang-Tan Lin¹  Jacopo Desiderio⁴  Su Yan³  Jian-Wei Xie¹  Jia-Bin Wang¹ 

[1] Department of Gastric Surgery, Fujian Medical University Union Hospital;Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University;Department of Gastrointestinal Surgery, Qinghai University Affiliated Hospital;Department of Digestive Surgery, St. Mary's Hospital, University of Perugia

关键词: Gastric cancer;    ypTNM staging;    Neoadjuvant therapy;    Modified;    Validation;   

DOI  :  10.1634/theoncologist.2020-0022

学科分类：地质学

来源: AlphaMed Press Incorporated

【 摘 要 】

Background The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging. Patients and Methods Clinicopathological data of 1,791 patients who underwent curative-intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy. Results In the development cohort, the 5-year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C-index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi-square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time-dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation ( n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05). Conclusion We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy. Implications for Practice The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi-institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.

【 授权许可】

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