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. 2012 Aug;19(8):2443-51.
doi: 10.1245/s10434-012-2403-6. Epub 2012 May 23.

The New American Joint Committee on Cancer/International Union Against Cancer staging system for adenocarcinoma of the stomach: increased complexity without clear improvement in predictive accuracy

Johan L Dikken  1 , Cornelis J H van de Velde, Mithat Gönen, Marcel Verheij, Murray F Brennan, Daniel G Coit
Affiliations

The New American Joint Committee on Cancer/International Union Against Cancer staging system for adenocarcinoma of the stomach: increased complexity without clear improvement in predictive accuracy

Johan L Dikken et al. Ann Surg Oncol. 2012 Aug.

Abstract

Purpose: To evaluate the changes in the 7th edition American Joint Committee on Cancer (AJCC) staging system for stomach cancer compared to the 6th edition; to compare the predictive accuracy of the two staging systems.

Methods: In a combined database containing 2,196 patients who underwent an R0 resection for gastric adenocarcinoma, differences between the two staging systems were evaluated and stage-specific survival estimates compared. Concordance probability and Brier scores were estimated for both systems to examine the predictive accuracy.

Results: Nodal status cutoff values were changed, leading to a more even distribution for the redefined N1, N2, and N3 group. AJCC 6th edition stage II reflected a highly heterogeneous population, which is now adequately subdivided in the AJCC 7th edition into stages IIA, IIB, and IIIA. The predictive accuracy of N classification improved significantly as measured by concordance. Despite increased complexity, the predictive accuracy of AJCC 7th stage grouping was significantly worse than that of the AJCC 6th edition.

Discussion: The increased complexity of the 7th edition staging system is accompanied by improvements in the predictive value of nodal staging as compared to the 6th edition, but it was no better in overall stage-specific predictive accuracy. Future refinements of the tumor, node, metastasis staging system should consider whether increased complexity is balanced by improved prognostic accuracy.

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Figures

Fig. 1
Fig. 1
a Distribution of T classification in the 6th and 7th edition AJCC staging system (n = 2,196). In the 7th edition staging system, former category T1 is divided into new categories T1a and T1b, whereas other T categories are redefined. b Distribution of N classification in the 6th and 7th edition AJCC staging systems (n = 2,196). In the 7th edition staging system, former category N1 is divided into new categories N1 and N2, and category N3 is redefined
Fig. 2
Fig. 2
a Disease-specific survival according to the 6th edition AJCC staging system (n = 2,196). b Disease-specific survival according to the 7th edition AJCC staging system (n = 2,196)
Fig. 3
Fig. 3
a AJCC 6th edition stage II patients (n = 467) are distributed between stages IIA, IIB, and IIIA in the 7th edition staging system. b AJCC 6th edition stage IIIA patients (n = 421) are distributed between stages IIIA and IIIB in the 7th edition staging system
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References

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