TY - JOUR
T1 - Comparison of the survival difference between AJCC 6th and 7th editions for gastric cancer patients
AU - Fang, Wen Liang
AU - Huang, Kuo Hung
AU - Chen, Jen Hao
AU - Lo, Su Shin
AU - Hsieh, Mao Chih
AU - Shen, King Han
AU - Li, Anna Fen Yau
AU - Niu, Dau Ming
AU - Chiou, Shih Hwa
AU - Wu, Chew Wun
PY - 2011/12
Y1 - 2011/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=83655167278&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=83655167278&partnerID=8YFLogxK
U2 - 10.1007/s00268-011-1275-4
DO - 10.1007/s00268-011-1275-4
M3 - Article
C2 - 21918892
AN - SCOPUS:83655167278
SN - 0364-2313
VL - 35
SP - 2723
EP - 2729
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 12
ER -
