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Multicenter Study
. 2025 Jan 1;111(1):718-727.
doi: 10.1097/JS9.0000000000001768.

Development of a staging system for hepatoid adenocarcinoma of the stomach based on multicenter data: a retrospective cohort study

Ying-Qi Huang  1   2 , Ze-Ning Huang  1   2 , Qing-Qi Hong  3 , Peng Zhang  4 , Zi-Zhen Zhang  5 , Liang He  6 , Liang Shang  7 , Lin-Jun Wang  8 , Ya-Feng Sun  9 , Zhi-Xiong Li  10 , Jun-Jie Liu  11 , Fang-Hui Ding  12 , En-De Lin  13 , Yong-An Fu  14 , Shuang-Ming Lin  15 , Qi-Yue Chen  1   2 , Chao-Hui Zheng  1   2 , Chang-Ming Huang  1   2 , Ping Li  1   2
Affiliations
Multicenter Study

Development of a staging system for hepatoid adenocarcinoma of the stomach based on multicenter data: a retrospective cohort study

Ying-Qi Huang et al. Int J Surg. .

Abstract

Background: Hepatoid adenocarcinoma of the stomach (HAS) is a rare subtype of gastric cancer (GC) with a poor prognosis. Furthermore, the current pathological staging system for HAS does not distinguish it from that for common gastric cancer (CGC).

Methods: The clinicopathological data of 251 patients with primary HAS who underwent radical surgery at 14 centers in China from April 2004 to December 2019 and 5082 patients with primary CGC who underwent radical surgery at two centers during the same period were retrospectively analyzed. A modified staging system was established based on the differences in survival.

Results: After 1:4 propensity score matching (PSM), 228 patients with HAS and 828 patients with CGC were analyzed. Kaplan-Meier (K-M) analysis showed patients with HAS had a poorer prognosis compared with CGC. Multivariate analysis identified pN stage, CEA level, and perineural invasion (PNI) as independent prognostic factors in patients with HAS. A modified pT (mpT) staging was derived using recursive partitioning analysis (RPA) incorporating PNI and pT staging. The modified pathological staging system (mpTNM) integrated the mpT and the eighth American Joint Committee on Cancer (AJCC) pN definitions. Multivariate analysis showed that the mpTNM stage outperformed other pathological variables as independent predictors of OS and RFS in patients with HAS. The mpTNM staging system exhibited significantly higher predictive accuracy for 3-year OS in patients with HAS (0.707, 95% CI: 0.650-0.763) compared to that of the eighth AJCC staging system (0.667, 95% CI: 0.610-0.723, P <0.05). Analysis using the Akaike information criterion favored the mpTNM staging system over the eighth AJCC staging system (824.69 vs. 835.94) regarding the goodness of fit. The mpTNM stages showed improved homogeneity in survival prediction (likelihood ratio: 41.51 vs. 27.10). Comparatively, the mpTNM staging system outperformed the eighth AJCC staging system in survival prediction, supported by improvements in the net reclassification index (NRI: 47.7%) and integrated discrimination improvement (IDI: 0.083, P <0.05). The time-dependent ROC curve showed that the mpTNM staging system consistently outperformed the eighth AJCC staging system with increasing observation time.

Conclusion: The mpTNM staging system exhibited superior postoperative prognostic accuracy for patients with HAS compared to the eighth AJCC staging system.

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Conflict of interest statement

The authors declare no conflicts of interest.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Modified pathological T stage (mpT stage). (A) Proposed mpT stage through RPA; (B) definition for mpT stage.
Figure 2
Figure 2
Predictive accuracy of pathological prognostic factors for prediction of OS in patients with HAS (the predictive accuracy for 3-year overall survival based on the iAUC with 1000× bootstrap resampling for each parameter is shown in a box plot. Median values of 1000× bootstrap resampling are shown with thick lines).
Figure 3
Figure 3
Time-dependent receiver operating characteristics (ROC) curves for the AJCC eighth edition pTNM staging system and the modified pTNM staging system.
See this image and copyright information in PMC

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