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. 2020 Oct:60:102979.
doi: 10.1016/j.ebiom.2020.102979. Epub 2020 Sep 24.

Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study

Zi-Hao Dai  1 , Qi-Wen Wang  1 , Qing-Wei Zhang  1 , Xia-Lin Yan  2 , Thomas Aparicio  3 , Yang-Yang Zhou  4 , Huan Wang  5 , Chi-Hao Zhang  6 , Aziz Zaanan  7 , Pauline Afchain  8 , Yan Zhang  1 , Hui-Min Chen  1 , Yun-Jie Gao  9 , Zhi-Zheng Ge  10
Affiliations

Personalized four-category staging for predicting prognosis in patients with small bowel Adenocarcinoma: an international development and validation study

Zi-Hao Dai et al. EBioMedicine. 2020 Oct.

Abstract

Background: Log odds of positive lymph nodes (LODDS) classification showed superiority over 8th edition N staging in predicting survival of small bowel adenocarcinoma (SBA) patients. The aim of this study was to develop and validate the Tumor, LODDS, and Metastasis (TLM) staging of SBA.

Methods: Totally 1789 SBA patients from the Surveillance, Epidemiology, and End Results (SEER) database between 1988-2010, 437 patients from SEER database between 2011-2013 and 166 patients from multicenters were categorized into development, validation and test cohort, respectively. The TLM staging was developed in the development cohort using Ensemble Algorithm for Clustering Cancer Data (EACCD) method. C-index was used to assess the performance of the TLM staging in predicting cancer-specific survival (CSS) and was compared with the traditional 8th edition TNM staging.

Findings: Four-category TLM staging designed for the development cohort showed higher discriminatory power than TNM staging in predicting CSS in the development cohort (0.682 vs. 0.650, P < 0.001), validation cohort (0.682 vs. 0.654, P = 0.022), and test cohort (0.659 vs. 0.611, P = 0.023), respectively. TLM staging continued to show its higher predictive efficacy than the 8th TNM in TNM stage II/III patients or in patients with lymph node yield less than 8.

Interpretation: TLM staging showed a better prognostic performance than the 8th TNM staging especially TNM stage II/III or patients with lymph node yield less than 8 and therefore, could serve to complement the TNM staging in patients with SBA.

Funding: A full list of funding bodies that contributed to this study can be found in the Acknowledgements section.

Keywords: Prediction; Prognosis; Small bowel adenocarcinoma; TLM stage; TNM stage.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig 1
Fig. 1
Development of the novel TLM staging. (A) Curve of C-index based on the dendrogram in (B). The number 0.6812 is the C-index corresponding to n = 4 prognostic groups. (B) Dendrogram (in black) for the development cohort. A 5-year survival rate is given beneath each combination. Cutting the dendrogram according to n = 4 in (A) creates 4 prognostic groups, shown in red square boxes. Listed on the bottom are the group numbers. (C) The novel TLM staging plotted according to the tree-structured dendrogram with unclassified combinations for T, LODDS and M classification. (D) The novel TLM stage plotted according to the tree-structured dendrogram after imputation for missing stages due to unclassified combinations.
Fig 2
Fig. 2
CSS (A, D, G), OS (B, E, H), RFS (I) and cumulative incidence of SBA-associated death under competing risk model (C, F, J) for the novel TLM staging in the development, validation, and test cohort, respectively. CSS: cancer specific survival; OS: overall survival; RFS: recurrence-free survival; SBA: small bowel adenocarcinoma; TLM: tumor, log odds of positive lymph nodes and metastasis.
Fig 3
Fig. 3
CSS (A, D, G), OS (B, E, H), RFS (I) and cumulative incidence of SBA-associated death under competing risk model (C, F, J) for the traditional 8th edition TNM staging in the development, validation, and test cohort, respectively. CSS: cancer specific survival; OS: overall survival; RFS: recurrence-free survival; TNM: tumor, log odds of positive lymph nodes and metastasis.
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