Dataset Information

Comparison of the 7th and 8th editions of the American joint committee on cancer TNM classification for patients with stage III gastric cancer.

ABSTRACT:

Background and objectives

The eighth TNM edition for gastric cancer was released in 2016 and included major revisions, especially of stage III. The purpose of this study was to evaluate the prognostic value of the new AJCC TNM classification in comparison with the 7th edition for stage III gastric cancer.

Methods

Clinical and histopathological data on 1,496 patients operated on for stage III GC according to the seventh edition between 2005 and 2013 were analyzed and compared using 7th and 8th classifications. The 2 systems were compared in terms of prognostic performance.

Results

The stage shifted for 650 (43.45%) patients: from IIIA to IIIB (2 patient, 0.13%), from IIIB to IIIA (214 patients, 14.30%), from IIIB to IIIC (99 patients, 6.62%), and from IIIC to IIIB (335 patients, 22.39%). Cox regression multivariate analysis showed both the 8th and 7th TNM classification were independent prognostic factors. The 8th edition system had higher linear trend and likelihood ratio χ² scores, and smaller AIC values compared with those for the 7th edition. However, the performance of the eighth edition did not reveal significant improvement compared to the seventh edition (c-index 0.625 vs. c-index 0.616, p=0.085).

Conclusion

The eighth TNM edition may not provide significantly better accuracy in predicting the prognosis of stage III GC. However, to confirm our findings, further studies are warranted.

SUBMITTER: Lu J

PROVIDER: S-EPMC5663535 | biostudies-literature | 2017 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Comparison of the 7th and 8th editions of the American joint committee on cancer TNM classification for patients with stage III gastric cancer.

Lu Jun J Zheng Chao-Hui CH Cao Long-Long LL Li Ping P Xie Jian-Wei JW Wang Jia-Bin JB Lin Jian-Xian JX Chen Qi-Yue QY Lin Mi M Tu Ru-Hong RH Huang Chang-Ming CM

Oncotarget 20170606 48

<h4>Background and objectives</h4>The eighth TNM edition for gastric cancer was released in 2016 and included major revisions, especially of stage III. The purpose of this study was to evaluate the prognostic value of the new AJCC TNM classification in comparison with the 7th edition for stage III gastric cancer.<h4>Methods</h4>Clinical and histopathological data on 1,496 patients operated on for stage III GC according to the seventh edition between 2005 and 2013 were analyzed and compared using ...[more]

PMID: 29137363

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Project description:This study compared the prognostic significance of staging between the American Joint Committee on Cancer 8th edition Tumor, Node, Metastasis (TNM) staging system and the Barcelona Clinic Liver Cancer (BCLC) classification in patients with hepatocellular carcinoma (HCC). The study population comprised patients with liver cancer registered in the Taiwan Cancer Database from 2007 to 2013 and was followed up until December 31, 2016. The study included patients with HCC, with known staging in both TNM and BCLC systems, and with follow-up >1 month. Primary endpoint was overall survival. Univariate and multivariate Cox proportional hazards model were constructed to investigate the significance of staging by two systems. Goodness-of-fit of model was evaluated via Akaike's information criterion (AIC), the lower the better. Among 73,136 patients with newly diagnosed liver cancer, a total of 37,062 patients with HCC (25.6% underwent surgery) were eligible. The mean age and overall survival of this cohort were 63.9 years and 27.2%, respectively. Overall survivals for stages I, II, III, and IV (the TNM system) were 54.5%, 34.9%, 10.3%, and 6.4%, respectively. Overall survivals for stages A, B, C, and D (the BCLC classification) were 54.5%, 29.2%, 9.8%, and 4.0%, respectively. The median follow-up time was 59.4 months. Multivariate Cox proportional hazards model revealed that both systems predicted overall survival, cancer-specific survival, disease-free survival, and local recurrence-free rate well. Values of ΔAIC of the BCLC classification and the TNM system were lower for the surgery group and nonsurgery group, respectively. The TNM system (8th edition) predicted long-term outcome better than the BCLC classification in patients with HCC. But in patients treated initially with surgery, the BCLC classification outperformed the 8th edition of the TNM system. IMPLICATIONS FOR PRACTICE: This work demonstrates that the Tumor, Node, Metastasis (TNM) system (8th edition) and the Barcelona Clinic Liver Cancer (BCLC) classification both predict long-term outcome significantly in patients with hepatocellular carcinoma but that the TNM system (8th edition) predicts long-term outcome better than the BCLC classification. For patients treated initially with surgery, BCLC classification outperforms in 8th edition TNM system in predicting long-term outcome.

Project description:Importance: The 8th edition of the American Joint Committee on Cancer (AJCC) staging manual incorporated new changes from its 7th edition for classifying retinoblastoma (RB). Objective: We assessed the comparative prognostic values of the 7th and 8th editions of the AJCC clinical (cTNM) staging manuals for RB and suggested modifications for future edition accordingly. Design: A retrospective, observational study. Setting: King Hussein Cancer Centre. Participants: A cohort of 478 patients and 565 eyes with RB. Main Outcomes and Measures: Main outcome measures included demographics; tumor features, AJCC cTNM stage, and eye salvage rates. The prognostic performance of the different staging systems was assessed with the concordance index (C-index) and likelihood ratio χ2 tests. Results: The overall eye salvage rate was 65%. Stage migration occurred for 330 (48%) eyes with the AJCC Staging Manual, 8th edition. Based on the 7th edition AJCC staging, the eye salvage rate was 94% (n=177) for T1 tumors (98% for T1a, 93%for T1b, and 90%for T1c), 69% (n=204) for T2 tumors (73% for T2a and 62%for T2b), and 51% (n=40) for T3 tumors. Based on the 8th edition AJCC staging, the eye salvage rate was 95% (n=139) for T1 tumors (98% for T1a and 93% for T1b), 68% (n=281) for T2 tumors (90%for T2a and 66%for T2b), and 12% (n=1) for T3 tumors. With our proposed cTNM modifications, the eye salvage rate was 94% (n=177) for T1 tumors (98%for T1a, 93%for T1b, and 90% for T1c), 66% (n=243) for T2 tumors (73% for T2a, 62% for T2b, and 55% for T2c), and 12% (n=1) for T3 tumors. As estimated by odds ratios, more advanced cTNM stage (regardless of the cTNM staging system) was significantly associated with an increased chance of treatment failure (P < .0001). The C-index for both the 8th edition and the proposed modifications were approximately equal, and both were higher than that of the 7th edition. However, the proposed modifications had the highest likelihood ratio χ2 value and the best bootstrap 95% confidence interval. Conclusions and Relevance: Our proposed modifications on the clinical TNM Staging System for RB harbor more detailed subgroup classification criteria that provides better prognostic value for eye globe salvage than the published similar (but not identical) AJCC Staging Manual, 7th and 8th editions, furthermore these modifications may resolve the discrepancies in the previously published different classification systems for RB.

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Dataset Information

Comparison of the 7th and 8th editions of the American joint committee on cancer TNM classification for patients with stage III gastric cancer.

Background and objectives

Methods

Results

Conclusion

Publications

Comparison of the 7th and 8th editions of the American joint committee on cancer TNM classification for patients with stage III gastric cancer.

Similar Datasets

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