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. 2018 Jan;21(1):74-83.
doi: 10.1007/s10120-017-0743-4. Epub 2017 Jun 22.

Evaluation of the American Joint Committee on Cancer 8th edition staging system for gastric cancer patients after preoperative therapy

Naruhiko Ikoma  1 , Mariela Blum  2 , Jeannelyn S Estrella  3 , Prajnan Das  4 , Wayne L Hofstetter  5 , Keith F Fournier  1 , Paul Mansfield  1 , Jaffer A Ajani  2 , Brian D Badgwell  6
Affiliations

Evaluation of the American Joint Committee on Cancer 8th edition staging system for gastric cancer patients after preoperative therapy

Naruhiko Ikoma et al. Gastric Cancer. 2018 Jan.

Abstract

Background: The American Joint Committee on Cancer (AJCC) recently released its 8th edition staging system, which created a separate staging system for gastric cancer patients who have undergone preoperative therapy (ypStage). The objective of this retrospective study was to apply the new ypStage to patients who have undergone preoperative therapy and potentially curative gastrectomy.

Methods: We collected data from a prospectively maintained institutional database of gastric cancer patients who underwent potentially curative gastrectomy after preoperative therapy (1995-2015). Kaplan-Meier survival estimations and log-rank tests were performed to compare survival. Univariable and multivariable analyses were performed to determine risk factors for overall survival.

Results: A total of 354 patients met our criteria. Most patients completed planned preoperative therapy (94%; 332/354) and received chemoradiation therapy (75%; 265/354). Although clinical stage (cStage) provided a poor discrimination of survival, postneoadjuvant pathological stage (ypStage) identified significant variation in survival (p < 0.001). Multivariable analysis showed the following factors were associated with survival after adjustment for ypStage: Asian race (HR 0.52; p = 0.028), linitis plastica (HR 1.66; p = 0.037), and R1 resection (HR 1.91; p = 0.016). Survival was not longer in ypT0N0 patients than in ypStage I patients (HR 1.29; p = 0.377).

Conclusions: The AJCC 8th edition staging system for gastric cancer demonstrated reasonable survival prediction by ypStage, but not cStage, in patients who had undergone preoperative therapy. ypT0N0 patients, although not defined in the 8th edition, may be considered for inclusion in the ypStage I group.

Keywords: AJCC 8th edition staging system; Gastric cancer; Preoperative therapy; Surgery; Survival.

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Conflict of interest statement

Conflict of interest The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Kaplan–Meier estimates for overall survival (OS) by cTNM stage group (a) and ypTNM stage group (b)
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