Takeshi Sano1, Daniel G Coit2, Hyung Ho Kim3, Franco Roviello4, Paulo Kassab5, Christian Wittekind6, Yuko Yamamoto7, Yasuo Ohashi7. 1. Department of Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. takeshi.sano@jfcr.or.jp. 2. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, USA. 3. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea. 4. Department of General Surgery and Surgical Oncology, University of Siena, Siena, Italy. 5. Department of Surgery, Santa Casa Medical School, Sao Paulo, Brazil. 6. Department of Pathology, Leipzig University, Leipzig, Germany. 7. Division of Biostatistics, Japan Clinical Research Support Unit, Tokyo, Japan.
Abstract
BACKGROUND: The current AJCC staging system for gastric cancer (AJCC7) incorporated several major revisions to the previous edition. The T and N categories and the stage groups were newly defined, and adenocarcinoma of the esophagogastric junction (EGJ) was reclassified and staged according to the esophageal system. Studies to validate these changes showed inconsistent results. The International Gastric Cancer Association (IGCA) launched a project to support evidence-based revisions to the next edition of the AJCC staging system. METHODS: Clinical and pathological data on patients who underwent curative gastrectomy at 59 institutions in 15 countries between 2000 and 2004 were retrospectively collected. Patients lost to follow-up within 5 years of surgery were excluded. Patients treated with neoadjuvant therapy were excluded. The data were analyzed in total, and separately by region of treatment. RESULTS: Of 25,411 eligible cases, 84.8 % were submitted from 24 institutions of Japan and Korea, 6.4 % from other Asian countries, and 8.8 % from 29 Western institutions. The T and N categories of AJCC7 clearly stratified the patient survival. Patients with pN3a and pN3b showed distinct prognosis in all regions, and by introducing pN3a and pN3b into a cluster analysis, we established a new stage grouping with better stratification than AJCC7, especially among stage III subgroups. Survival of Siewert type 2 and 3 EGJ tumors was better stratified by this IGCA stage grouping than by either esophageal or gastric scheme of AJCC7. CONCLUSIONS: For the next revision of AJCC classification, we propose a new stage grouping based on a large, worldwide data collection.
BACKGROUND: The current AJCC staging system for gastric cancer (AJCC7) incorporated several major revisions to the previous edition. The T and N categories and the stage groups were newly defined, and adenocarcinoma of the esophagogastric junction (EGJ) was reclassified and staged according to the esophageal system. Studies to validate these changes showed inconsistent results. The International Gastric Cancer Association (IGCA) launched a project to support evidence-based revisions to the next edition of the AJCC staging system. METHODS: Clinical and pathological data on patients who underwent curative gastrectomy at 59 institutions in 15 countries between 2000 and 2004 were retrospectively collected. Patients lost to follow-up within 5 years of surgery were excluded. Patients treated with neoadjuvant therapy were excluded. The data were analyzed in total, and separately by region of treatment. RESULTS: Of 25,411 eligible cases, 84.8 % were submitted from 24 institutions of Japan and Korea, 6.4 % from other Asian countries, and 8.8 % from 29 Western institutions. The T and N categories of AJCC7 clearly stratified the patient survival. Patients with pN3a and pN3b showed distinct prognosis in all regions, and by introducing pN3a and pN3b into a cluster analysis, we established a new stage grouping with better stratification than AJCC7, especially among stage III subgroups. Survival of Siewert type 2 and 3 EGJ tumors was better stratified by this IGCA stage grouping than by either esophageal or gastric scheme of AJCC7. CONCLUSIONS: For the next revision of AJCC classification, we propose a new stage grouping based on a large, worldwide data collection.
Authors: T W Rice; V W Rusch; C Apperson-Hansen; M S Allen; L-Q Chen; J G Hunter; K A Kesler; S Law; T E M R Lerut; C E Reed; J A Salo; W J Scott; S G Swisher; T J Watson; E H Blackstone Journal: Dis Esophagus Date: 2009 Impact factor: 3.429
Authors: Alyson L Mahar; Brandon Zagorski; Daniel Kagedan; Matthew Dixon; Abraham El-Sedfy; Jovanka Vasilevska-Ristovska; Daniela Cortinovis; Corwyn Rowsell; Calvin Law; Lucy Helyer; Lawrence Paszat; Natalie Coburn Journal: Can J Public Health Date: 2018-08-08