Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Providing Reliable Prognosis to Patients with Gastric Cancer in the Era of Neoadjuvant Therapies: Comparison of AJCC Staging Schemata

  • Kim, Gina (Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine) ;
  • Friedmann, Patricia (Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine) ;
  • Solsky, Ian (Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine) ;
  • Muscarella, Peter (Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine) ;
  • McAuliffe, John (Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine) ;
  • In, Haejin (Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine)
  • Received : 2020.08.31
  • Accepted : 2020.10.23
  • Published : 2020.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Patients with gastric cancer who receive neoadjuvant therapy are staged before treatment (cStage) and after treatment (ypStage). We aimed to compare the prognostic reliability of cStage and ypStage, alone and in combination. Materials and Methods: Data for all patients who received neoadjuvant therapy followed by surgery for gastric adenocarcinoma from 2004 to 2015 were extracted from the National Cancer Database. Kaplan-Meier (KM)curves were used to model overall survival based on cStage alone, ypStage alone, cStage stratified by ypStage, and ypStage stratified by cStage. P-values were generated to summarize the differences in KM curves. The discriminatory power of survival prediction was examined using Harrell's C-statistics. Results: We included 8,977 patients in the analysis. As expected, increasing cStage and ypStage were associated with worse survival. The discriminatory prognostic power provided by cStage was poor (C-statistic 0.548), while that provided by ypStage was moderate (C-statistic 0.634). Within each cStage, the addition of ypStage information significantly altered the prognosis (P<0.0001 within cStages I-IV). However, for each ypStage, the addition of cStage information generally did not alter the prognosis (P=0.2874, 0.027, 0.061, 0.049, and 0.007 within ypStages 0-IV, respectively). The discriminatory prognostic power provided by the combination of cStage and ypStage was similar to that of ypStage alone (C-statistic 0.636 vs. 0.634). Conclusions: The cStage is unreliable for prognosis, and ypStage is moderately reliable. Combining cStage and ypStage does not improve the discriminatory prognostic power provided by ypStage alone. A ypStage-based prognosis is minimally affected by the initial cStage.

Keywords

References

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018;68:7-30. https://doi.org/10.3322/caac.21442
  2. National Comprehensive Cancer Network. Gastric cancer (version 1.2019) [Internet]. Plymouth Meeting (PA): National Comprehensive Cancer Network; 2019 [cited 2019 Mar 22]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf.
  3. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 8th ed. Chicago (IL): Springer, 2017.
  4. In H, Ravetch E, Langdon-Embry M, Palis B, Ajani JA, Hofstetter WL, et al. The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging. Gastric Cancer 2018;21:1-9. https://doi.org/10.1007/s10120-017-0765-y
  5. Ikoma N, Blum M, Estrella JS, Das P, Hofstetter WL, Fournier KF, et al. Evaluation of the American Joint Committee on Cancer 8th edition staging system for gastric cancer patients after preoperative therapy. Gastric Cancer 2018;21:74-83. https://doi.org/10.1007/s10120-017-0743-4
  6. American College of Surgeons. About the National Cancer Database [Internet]. Chicago (IL): American College of Surgeons; 2019 [cited 2019 Jul 10]. Available from: https://www.facs.org/quality-programs/cancer/ncdb/about.
  7. Rohatgi PR, Mansfield PF, Crane CH, Wu TT, Sunder PK, Ross WA, et al. Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma. Cancer 2006;107:1475-1482. https://doi.org/10.1002/cncr.22180
  8. Ajani JA, Mansfield PF, Crane CH, Wu TT, Lunagomez S, Lynch PM, et al. Paclitaxel-based chemoradiotherapy in localized gastric carcinoma: degree of pathologic response and not clinical parameters dictated patient outcome. J Clin Oncol 2005;23:1237-1244. https://doi.org/10.1200/JCO.2005.01.305
  9. Ikoma N, Lee JH, Bhutani MS, Ross WA, Weston B, Chiang YJ, et al. Preoperative accuracy of gastric cancer staging in patient selection for preoperative therapy: race may affect accuracy of endoscopic ultrasonography. J Gastrointest Oncol 2017;8:1009-1017. https://doi.org/10.21037/jgo.2017.04.04
  10. Fairweather M, Jajoo K, Sainani N, Bertagnolli MM, Wang J. Accuracy of EUS and CT imaging in preoperative gastric cancer staging. J Surg Oncol 2015;111:1016-1020. https://doi.org/10.1002/jso.23919
  11. Patel PR, Mansfield PF, Crane CH, Wu TT, Lee JH, Lynch PM, et al. Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer. Cancer 2007;110:989-995. https://doi.org/10.1002/cncr.22870
  12. Ikoma N, Estrella JS, Hofstetter W, Das P, Minsky BD, Ajani JA, et al. Nodal downstaging in gastric cancer patients: promising survival if ypN0 is achieved. Ann Surg Oncol 2018;25:2012-2017. https://doi.org/10.1245/s10434-018-6471-0
  13. Smyth EC, Fassan M, Cunningham D, Allum WH, Okines AF, Lampis A, et al. Effect of pathologic tumor response and nodal status on survival in the medical research council adjuvant gastric infusional chemotherapy trial. J Clin Oncol 2016;34:2721-2727. https://doi.org/10.1200/JCO.2015.65.7692
  14. Kim SJ, Kim HH, Kim YH, Hwang SH, Lee HS, Park DJ, et al. Peritoneal metastasis: detection with 16- or 64-detector row CT in patients undergoing surgery for gastric cancer. Radiology 2009;253:407-415. https://doi.org/10.1148/radiol.2532082272
  15. Mizrak Kaya D, Nogueras-Gonzalez GM, Harada K, Amlashi FG, Roy-Chowdhuri S, Estrella JS, et al. Risk of peritoneal metastases in patients who had negative peritoneal staging and received therapy for localized gastric adenocarcinoma. J Surg Oncol 2018;117:678-684. https://doi.org/10.1002/jso.24912