Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi‐Institutional Study
Background The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to devel...
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| Veröffentlicht in: | The oncologist (Dayton, Ohio) Ohio), 2021-01, Vol.26 (1), p.e99-e110 |
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| creator | Zhong, Qing Chen, Qi‐Yue Parisi, Amilcare Ma, Yu‐Bin Lin, Guang‐Tan Desiderio, Jacopo Yan, Su Xie, Jian‐Wei Wang, Jia‐Bin Hou, Jun‐Fang Lin, Jian‐Xian Lu, Jun Cao, Long‐Long Lin, Mi Tu, Ru‐Hong Huang, Ze‐Ning Lin, Ju‐Li Liu, Zhi‐Yu Que, Si‐Jin Li, Ping Zheng, Chao‐Hui Huang, Chang‐Ming |
| description | Background
The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging.
Patients and Methods
Clinicopathological data of 1,791 patients who underwent curative‐intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy.
Results
In the development cohort, the 5‐year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C‐index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi‐square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time‐dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation (n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05).
Conclusion
We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy.
Implications for Practice
The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi‐institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.
The 8th edition of the AJCC Staging Manual first proposed ypTNM staging for gastric cancer, but its accuracy is controversial. Modified ypTNM stagin |
| doi_str_mv | 10.1634/theoncologist.2020-0022 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7794192</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A780933804</galeid><sourcerecordid>A780933804</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5201-8a84b09106aa05bf9b266dcd3118afe04cdc7b23b9572b22c7c239962167050f3</originalsourceid><addsrcrecordid>eNqNks1u1DAUhSMEoqXwChCJDZsM13Z-bBZIowhKpc7MgkFiZzmOk3GVsae2U5Qdj8Az8iQ4mlIYiQWyZF_Z53z-O0nyCsEClSR_G3bKGmkH22sfFhgwZAAYP0rOUZGzLGfw9XGsgZKsQgU7S555fwMQS4KfJmcE0zKnOZwntyvb6k6rNp0O2_Uq_RxEr02f1oPwPi5IEbQ1aWddeil8cFqmtTBSuVR0IfZrZUV7M94JE9LtTjlxmN6ly3Q1DkH__P7jyvigwzgzxBDhYzs9T550YvDqxf14kXz5-GFbf8quN5dX9fI6kwUGlFFB8wYYglIIKJqONbgsW9kShKjoFOSylVWDScOKCjcYy0piwliJUVlBAR25SN4fuYex2atWKhOcGPjB6b1wE7dC89MVo3e8t3e8qliOGI6AN_cAZ29H5QPfay_VMAij7Og5zgllDFGWR-nro7QXg-LadDYS5Szny4oCI4TCrFr8QxVbq_ZaWqM6HedPDNXRIJ313qnu4fQI-JwDfpIDPueAzzmIzpd_X_7B9_vj_7zOt7jn9L9cvlnXG0QKQOQXmJXI-w</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2438991894</pqid></control><display><type>article</type><title>Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi‐Institutional Study</title><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Oxford Journals Open Access Collection</source><source>PubMed Central</source><creator>Zhong, Qing ; Chen, Qi‐Yue ; Parisi, Amilcare ; Ma, Yu‐Bin ; Lin, Guang‐Tan ; Desiderio, Jacopo ; Yan, Su ; Xie, Jian‐Wei ; Wang, Jia‐Bin ; Hou, Jun‐Fang ; Lin, Jian‐Xian ; Lu, Jun ; Cao, Long‐Long ; Lin, Mi ; Tu, Ru‐Hong ; Huang, Ze‐Ning ; Lin, Ju‐Li ; Liu, Zhi‐Yu ; Que, Si‐Jin ; Li, Ping ; Zheng, Chao‐Hui ; Huang, Chang‐Ming</creator><creatorcontrib>Zhong, Qing ; Chen, Qi‐Yue ; Parisi, Amilcare ; Ma, Yu‐Bin ; Lin, Guang‐Tan ; Desiderio, Jacopo ; Yan, Su ; Xie, Jian‐Wei ; Wang, Jia‐Bin ; Hou, Jun‐Fang ; Lin, Jian‐Xian ; Lu, Jun ; Cao, Long‐Long ; Lin, Mi ; Tu, Ru‐Hong ; Huang, Ze‐Ning ; Lin, Ju‐Li ; Liu, Zhi‐Yu ; Que, Si‐Jin ; Li, Ping ; Zheng, Chao‐Hui ; Huang, Chang‐Ming</creatorcontrib><description>Background
The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging.
Patients and Methods
Clinicopathological data of 1,791 patients who underwent curative‐intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy.
Results
In the development cohort, the 5‐year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C‐index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi‐square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time‐dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation (n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05).
Conclusion
We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy.
Implications for Practice
The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi‐institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.
The 8th edition of the AJCC Staging Manual first proposed ypTNM staging for gastric cancer, but its accuracy is controversial. Modified ypTNM staging is needed. This article reports a modified staging system that allows for a more accurate assessment of the prognosis of gastric cancer patients after neoadjuvant therapy.</description><identifier>ISSN: 1083-7159</identifier><identifier>EISSN: 1549-490X</identifier><identifier>DOI: 10.1634/theoncologist.2020-0022</identifier><identifier>PMID: 32864840</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Adjuvant treatment ; Cancer ; Care and treatment ; Development and progression ; Diagnosis ; Epidemiology ; Evaluation ; Gastric cancer ; Gastrointestinal Cancer ; Health aspects ; Methods ; Modified ; Neoadjuvant therapy ; Oncology, Experimental ; Patient outcomes ; Prognosis ; Stomach cancer ; Tumor staging ; Validation ; ypTNM staging</subject><ispartof>The oncologist (Dayton, Ohio), 2021-01, Vol.26 (1), p.e99-e110</ispartof><rights>2020 AlphaMed Press</rights><rights>2020 AlphaMed Press.</rights><rights>COPYRIGHT 2021 Oxford University Press</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5201-8a84b09106aa05bf9b266dcd3118afe04cdc7b23b9572b22c7c239962167050f3</citedby><cites>FETCH-LOGICAL-c5201-8a84b09106aa05bf9b266dcd3118afe04cdc7b23b9572b22c7c239962167050f3</cites><orcidid>0000-0002-0019-885X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794192/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794192/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,724,777,781,882,1412,27905,27906,45555,45556,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32864840$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhong, Qing</creatorcontrib><creatorcontrib>Chen, Qi‐Yue</creatorcontrib><creatorcontrib>Parisi, Amilcare</creatorcontrib><creatorcontrib>Ma, Yu‐Bin</creatorcontrib><creatorcontrib>Lin, Guang‐Tan</creatorcontrib><creatorcontrib>Desiderio, Jacopo</creatorcontrib><creatorcontrib>Yan, Su</creatorcontrib><creatorcontrib>Xie, Jian‐Wei</creatorcontrib><creatorcontrib>Wang, Jia‐Bin</creatorcontrib><creatorcontrib>Hou, Jun‐Fang</creatorcontrib><creatorcontrib>Lin, Jian‐Xian</creatorcontrib><creatorcontrib>Lu, Jun</creatorcontrib><creatorcontrib>Cao, Long‐Long</creatorcontrib><creatorcontrib>Lin, Mi</creatorcontrib><creatorcontrib>Tu, Ru‐Hong</creatorcontrib><creatorcontrib>Huang, Ze‐Ning</creatorcontrib><creatorcontrib>Lin, Ju‐Li</creatorcontrib><creatorcontrib>Liu, Zhi‐Yu</creatorcontrib><creatorcontrib>Que, Si‐Jin</creatorcontrib><creatorcontrib>Li, Ping</creatorcontrib><creatorcontrib>Zheng, Chao‐Hui</creatorcontrib><creatorcontrib>Huang, Chang‐Ming</creatorcontrib><title>Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi‐Institutional Study</title><title>The oncologist (Dayton, Ohio)</title><addtitle>Oncologist</addtitle><description>Background
The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging.
Patients and Methods
Clinicopathological data of 1,791 patients who underwent curative‐intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy.
Results
In the development cohort, the 5‐year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C‐index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi‐square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time‐dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation (n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05).
Conclusion
We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy.
Implications for Practice
The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi‐institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.
The 8th edition of the AJCC Staging Manual first proposed ypTNM staging for gastric cancer, but its accuracy is controversial. Modified ypTNM staging is needed. This article reports a modified staging system that allows for a more accurate assessment of the prognosis of gastric cancer patients after neoadjuvant therapy.</description><subject>Adjuvant treatment</subject><subject>Cancer</subject><subject>Care and treatment</subject><subject>Development and progression</subject><subject>Diagnosis</subject><subject>Epidemiology</subject><subject>Evaluation</subject><subject>Gastric cancer</subject><subject>Gastrointestinal Cancer</subject><subject>Health aspects</subject><subject>Methods</subject><subject>Modified</subject><subject>Neoadjuvant therapy</subject><subject>Oncology, Experimental</subject><subject>Patient outcomes</subject><subject>Prognosis</subject><subject>Stomach cancer</subject><subject>Tumor staging</subject><subject>Validation</subject><subject>ypTNM staging</subject><issn>1083-7159</issn><issn>1549-490X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqNks1u1DAUhSMEoqXwChCJDZsM13Z-bBZIowhKpc7MgkFiZzmOk3GVsae2U5Qdj8Az8iQ4mlIYiQWyZF_Z53z-O0nyCsEClSR_G3bKGmkH22sfFhgwZAAYP0rOUZGzLGfw9XGsgZKsQgU7S555fwMQS4KfJmcE0zKnOZwntyvb6k6rNp0O2_Uq_RxEr02f1oPwPi5IEbQ1aWddeil8cFqmtTBSuVR0IfZrZUV7M94JE9LtTjlxmN6ly3Q1DkH__P7jyvigwzgzxBDhYzs9T550YvDqxf14kXz5-GFbf8quN5dX9fI6kwUGlFFB8wYYglIIKJqONbgsW9kShKjoFOSylVWDScOKCjcYy0piwliJUVlBAR25SN4fuYex2atWKhOcGPjB6b1wE7dC89MVo3e8t3e8qliOGI6AN_cAZ29H5QPfay_VMAij7Og5zgllDFGWR-nro7QXg-LadDYS5Szny4oCI4TCrFr8QxVbq_ZaWqM6HedPDNXRIJ313qnu4fQI-JwDfpIDPueAzzmIzpd_X_7B9_vj_7zOt7jn9L9cvlnXG0QKQOQXmJXI-w</recordid><startdate>202101</startdate><enddate>202101</enddate><creator>Zhong, Qing</creator><creator>Chen, Qi‐Yue</creator><creator>Parisi, Amilcare</creator><creator>Ma, Yu‐Bin</creator><creator>Lin, Guang‐Tan</creator><creator>Desiderio, Jacopo</creator><creator>Yan, Su</creator><creator>Xie, Jian‐Wei</creator><creator>Wang, Jia‐Bin</creator><creator>Hou, Jun‐Fang</creator><creator>Lin, Jian‐Xian</creator><creator>Lu, Jun</creator><creator>Cao, Long‐Long</creator><creator>Lin, Mi</creator><creator>Tu, Ru‐Hong</creator><creator>Huang, Ze‐Ning</creator><creator>Lin, Ju‐Li</creator><creator>Liu, Zhi‐Yu</creator><creator>Que, Si‐Jin</creator><creator>Li, Ping</creator><creator>Zheng, Chao‐Hui</creator><creator>Huang, Chang‐Ming</creator><general>John Wiley & Sons, Inc</general><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0019-885X</orcidid></search><sort><creationdate>202101</creationdate><title>Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi‐Institutional Study</title><author>Zhong, Qing ; Chen, Qi‐Yue ; Parisi, Amilcare ; Ma, Yu‐Bin ; Lin, Guang‐Tan ; Desiderio, Jacopo ; Yan, Su ; Xie, Jian‐Wei ; Wang, Jia‐Bin ; Hou, Jun‐Fang ; Lin, Jian‐Xian ; Lu, Jun ; Cao, Long‐Long ; Lin, Mi ; Tu, Ru‐Hong ; Huang, Ze‐Ning ; Lin, Ju‐Li ; Liu, Zhi‐Yu ; Que, Si‐Jin ; Li, Ping ; Zheng, Chao‐Hui ; Huang, Chang‐Ming</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5201-8a84b09106aa05bf9b266dcd3118afe04cdc7b23b9572b22c7c239962167050f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adjuvant treatment</topic><topic>Cancer</topic><topic>Care and treatment</topic><topic>Development and progression</topic><topic>Diagnosis</topic><topic>Epidemiology</topic><topic>Evaluation</topic><topic>Gastric cancer</topic><topic>Gastrointestinal Cancer</topic><topic>Health aspects</topic><topic>Methods</topic><topic>Modified</topic><topic>Neoadjuvant therapy</topic><topic>Oncology, Experimental</topic><topic>Patient outcomes</topic><topic>Prognosis</topic><topic>Stomach cancer</topic><topic>Tumor staging</topic><topic>Validation</topic><topic>ypTNM staging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhong, Qing</creatorcontrib><creatorcontrib>Chen, Qi‐Yue</creatorcontrib><creatorcontrib>Parisi, Amilcare</creatorcontrib><creatorcontrib>Ma, Yu‐Bin</creatorcontrib><creatorcontrib>Lin, Guang‐Tan</creatorcontrib><creatorcontrib>Desiderio, Jacopo</creatorcontrib><creatorcontrib>Yan, Su</creatorcontrib><creatorcontrib>Xie, Jian‐Wei</creatorcontrib><creatorcontrib>Wang, Jia‐Bin</creatorcontrib><creatorcontrib>Hou, Jun‐Fang</creatorcontrib><creatorcontrib>Lin, Jian‐Xian</creatorcontrib><creatorcontrib>Lu, Jun</creatorcontrib><creatorcontrib>Cao, Long‐Long</creatorcontrib><creatorcontrib>Lin, Mi</creatorcontrib><creatorcontrib>Tu, Ru‐Hong</creatorcontrib><creatorcontrib>Huang, Ze‐Ning</creatorcontrib><creatorcontrib>Lin, Ju‐Li</creatorcontrib><creatorcontrib>Liu, Zhi‐Yu</creatorcontrib><creatorcontrib>Que, Si‐Jin</creatorcontrib><creatorcontrib>Li, Ping</creatorcontrib><creatorcontrib>Zheng, Chao‐Hui</creatorcontrib><creatorcontrib>Huang, Chang‐Ming</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The oncologist (Dayton, Ohio)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhong, Qing</au><au>Chen, Qi‐Yue</au><au>Parisi, Amilcare</au><au>Ma, Yu‐Bin</au><au>Lin, Guang‐Tan</au><au>Desiderio, Jacopo</au><au>Yan, Su</au><au>Xie, Jian‐Wei</au><au>Wang, Jia‐Bin</au><au>Hou, Jun‐Fang</au><au>Lin, Jian‐Xian</au><au>Lu, Jun</au><au>Cao, Long‐Long</au><au>Lin, Mi</au><au>Tu, Ru‐Hong</au><au>Huang, Ze‐Ning</au><au>Lin, Ju‐Li</au><au>Liu, Zhi‐Yu</au><au>Que, Si‐Jin</au><au>Li, Ping</au><au>Zheng, Chao‐Hui</au><au>Huang, Chang‐Ming</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi‐Institutional Study</atitle><jtitle>The oncologist (Dayton, Ohio)</jtitle><addtitle>Oncologist</addtitle><date>2021-01</date><risdate>2021</risdate><volume>26</volume><issue>1</issue><spage>e99</spage><epage>e110</epage><pages>e99-e110</pages><issn>1083-7159</issn><eissn>1549-490X</eissn><abstract>Background
The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging.
Patients and Methods
Clinicopathological data of 1,791 patients who underwent curative‐intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy.
Results
In the development cohort, the 5‐year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C‐index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi‐square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time‐dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation (n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05).
Conclusion
We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy.
Implications for Practice
The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi‐institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.
The 8th edition of the AJCC Staging Manual first proposed ypTNM staging for gastric cancer, but its accuracy is controversial. Modified ypTNM staging is needed. This article reports a modified staging system that allows for a more accurate assessment of the prognosis of gastric cancer patients after neoadjuvant therapy.</abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32864840</pmid><doi>10.1634/theoncologist.2020-0022</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-0019-885X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Oxford Journals Open Access Collection; PubMed Central |
| subjects | Adjuvant treatment Cancer Care and treatment Development and progression Diagnosis Epidemiology Evaluation Gastric cancer Gastrointestinal Cancer Health aspects Methods Modified Neoadjuvant therapy Oncology, Experimental Patient outcomes Prognosis Stomach cancer Tumor staging Validation ypTNM staging |
| title | Modified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi‐Institutional Study |
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