Alyson L Mahar1,2,3, Brandon Zagorski4, Daniel Kagedan5,6, Matthew Dixon5,6, Abraham El-Sedfy5, Jovanka Vasilevska-Ristovska7, Daniela Cortinovis8, Corwyn Rowsell9, Calvin Law4,6,10, Lucy Helyer11, Lawrence Paszat4,10, Natalie Coburn4,6,10. 1. Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada. alyson_mahar@cpe.umanitoba.ca. 2. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. alyson_mahar@cpe.umanitoba.ca. 3. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada. alyson_mahar@cpe.umanitoba.ca. 4. Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. 5. Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada. 6. Department of Surgery, University of Toronto, Toronto, ON, Canada. 7. Hospital for Sick Children, Toronto, ON, Canada. 8. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. 9. St. Michael's Hospital, Toronto, ON, Canada. 10. Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 11. Department of Surgery, Dalhousie University, Halifax, NS, Canada.
Abstract
OBJECTIVES: TNM stage is the preeminent cancer staging system and a fundamental determinant of disease prognosis. Our goal was to evaluate the predictive power of TNM stage for gastric adenocarcinoma (GAC), in a low-incidence country. METHODS: A province-wide chart review of GAC patients diagnosed from April 1, 2005 to March 31, 2008 was conducted in Ontario and linked to routinely collected vital status data with a follow-up on March 31, 2012. TNM staging was classified using the sixth and seventh Union International for Cancer Control/American Joint Committee on Cancer editions. Kaplan-Meier and log-rank tests compared stage-stratified survival estimates. Discrimination was evaluated using Harrell's C statistic. RESULTS: The cohort included 2366 patients. One- and 5-year survival was 43% and 17%. Using the sixth edition, 9% of patients had stage I disease, 5.4% stage II, 7.3% stage III, and 64% stage IV; 15% were not staged. Using the seventh edition, 9% were stage I, 7.7% stage II, 16% stage III, and 54% stage IV; 14% were not staged. Stage-stratified 5-year survival ranged from 68% to 7% with the sixth edition and from 70% to 4% with the seventh edition. Harrell's C statistic was 0.64 (0.63-0.65) for the broad sixth edition staging categories and 0.68 (0.67-0.69) for the broad seventh edition. Discriminative power was similar for the refined stage categories and across multiple subgroup analyses; it was best in non-metastatic patients. CONCLUSION: Existing staging systems for GAC used in North America predict individualized prognosis poorly. The creation of a more complex prediction tool is necessary to provide accurate and precise prognostication information to oncologists, patients, and their families.
OBJECTIVES:TNM stage is the preeminent cancer staging system and a fundamental determinant of disease prognosis. Our goal was to evaluate the predictive power of TNM stage for gastric adenocarcinoma (GAC), in a low-incidence country. METHODS: A province-wide chart review of GACpatients diagnosed from April 1, 2005 to March 31, 2008 was conducted in Ontario and linked to routinely collected vital status data with a follow-up on March 31, 2012. TNM staging was classified using the sixth and seventh Union International for Cancer Control/American Joint Committee on Cancer editions. Kaplan-Meier and log-rank tests compared stage-stratified survival estimates. Discrimination was evaluated using Harrell's C statistic. RESULTS: The cohort included 2366 patients. One- and 5-year survival was 43% and 17%. Using the sixth edition, 9% of patients had stage I disease, 5.4% stage II, 7.3% stage III, and 64% stage IV; 15% were not staged. Using the seventh edition, 9% were stage I, 7.7% stage II, 16% stage III, and 54% stage IV; 14% were not staged. Stage-stratified 5-year survival ranged from 68% to 7% with the sixth edition and from 70% to 4% with the seventh edition. Harrell's C statistic was 0.64 (0.63-0.65) for the broad sixth edition staging categories and 0.68 (0.67-0.69) for the broad seventh edition. Discriminative power was similar for the refined stage categories and across multiple subgroup analyses; it was best in non-metastatic patients. CONCLUSION: Existing staging systems for GAC used in North America predict individualized prognosis poorly. The creation of a more complex prediction tool is necessary to provide accurate and precise prognostication information to oncologists, patients, and their families.
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