Comparison of the Survival Difference Between AJCC 6th and 7th Editions for Gastric Cancer Patients.

Fang, Wen-Liang; Huang, Kuo-Hung; Chen, Jen-Hao; Lo, Su-Shin; Hsieh, Mao-Chih; Shen, King-Han; Li, Anna; Niu, Dau-Ming; Chiou, Shih-Hwa; Wu, Chew-Wun

Background: The AJCC 7th edition changes the classification of T- and N-factors and the TNM stage of gastric cancer. We evaluated its prognostic impact. Methods: From December 1987 to December 2006, a total of 1,380 patients underwent curative surgery for gastric cancer at the Department of Surgery, Taipei Veterans General Hospital, with a retrieved lymph node number ≥15. Survival was compared for disease classified according to the AJCC 6th and 7th editions. Results: There is a significant difference in 5-year survival between T2 and T3 gastric cancer classified according to the AJCC 7th edition (75.2 vs. 54.9%, p < 0.001), as well as between N1 and N2 (71.4 vs. 44.1%, p < 0.001). Although patients with N3a had a better 5-year survival than did those with N3b (27.6 vs. 11.3%, p < 0.001), the N3 categories were combined and not applied in the TNM stage in the 7th edition. Multivariate analysis using Cox's proportional hazards model with a forward logistics regression stepwise procedure demonstrates that age, N category of 6th edition, and T and N categories of 7th edition are independent prognostic factors; however, T category of 6th edition is no longer significant. Furthermore, the discriminative power of survival difference between each TNM stage seems to be comparable between the 6th and 7th editions. Conclusions: The AJCC 7th edition provides a more stratified survival difference in staging of gastric cancer. Future division of N3a and N3b in the classification of the TNM stage is recommended.

STOMACH cancer; HEALTH outcome assessment; CANCER patient medical care; PROPORTIONAL hazards models; MULTIVARIATE analysis

World Journal of Surgery, 2011, Vol 35, Issue 12, p2723

0364-2313

Academic Journal

10.1007/s00268-011-1275-4