J Lu1,2,3,4, Y J Zhao5, Y Zhou6, Q He7, Y Tian8, H Hao9, X Qiu10, L Jiang11, G Zhao12, C-M Huang1,2,3,4. 1. Departments of Gastric Surgery. 2. General Surgery, Fujian Medical University Union Hospital. 3. Key Laboratory of Ministry of Education of Gastrointestinal Cancer. 4. Fujian Key Laboratory of Tumour Microbiology, Fujian Medical University. 5. Department of Gastrointestinal Surgery, West District of the First Affiliated Hospital of the University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei. 6. Department of Gastrointestinal Surgery, Affiliated Hospital of Qingdao University, Qingdao. 7. Department of Gastrointestinal Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou. 8. Department of Pancreatic and Gastric Surgery, National Cancer Centre/National Clinical Research Centre for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing. 9. Department of General Surgery, Huashan Hospital, Fudan University. 10. Department of Gastrointestinal Surgery and Gastrointestinal Surgery Research Institute, Affiliated Hospital of Putian University, Putian. 11. Department of Gastrointestinal Surgery, Yan Tai Yu Huang Ding Hospital, Yantai, China. 12. Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai.
Abstract
BACKGROUND: The prognostic values of the AJCC staging system for gastric cancer (GC-AJCC), the AJCC staging system for gastric neuroendocrine tumours (NET-AJCC) and the European Neuroendocrine Tumor Society (ENETS) system for gastric neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma (MA)NEC remain controversial. METHODS: Data on patients with (MA)NEC from 21 centres in China were analysed. Different staging systems were evaluated by performing Kaplan-Meier survival analysis and calculating the concordance index (C-index) and Akaike information criterion (AIC). Based on three existing systems, a modified staging system (mTNM) was developed. RESULTS: A total of 871 patients were included. In the GC-AJCC system, an overlap was noticed for pT2 and pT3 categories. Patients with stage IIIC disease had a similar prognosis to those with stage IV disease. The pT categories of the NET-AJCC system had a lower C-index and higher AIC than those of the other systems. In the ENETS system, there was a low proportion (0·2 per cent) of patients with stage IIIA and a high proportion (67·6 per cent) of stage IIIB disease. The mTNM system adopted the NET-AJCC pT and GC-AJCC pN and pM definitions, and was developed based on the ENETS stage definitions. The proportion of patients in each stage was better distributed and the mTNM system showed improved prognostic performance in predicting overall and disease-free survival. CONCLUSION: The mTNM system offers more accurate prognostic value for gastric (MA)NEC than the AJCC or ENETS staging systems.
BACKGROUND: The prognostic values of the AJCC staging system for gastric cancer (GC-AJCC), the AJCC staging system for gastric neuroendocrine tumours (NET-AJCC) and the European Neuroendocrine Tumor Society (ENETS) system for gastric neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma (MA)NEC remain controversial. METHODS: Data on patients with (MA)NEC from 21 centres in China were analysed. Different staging systems were evaluated by performing Kaplan-Meier survival analysis and calculating the concordance index (C-index) and Akaike information criterion (AIC). Based on three existing systems, a modified staging system (mTNM) was developed. RESULTS: A total of 871 patients were included. In the GC-AJCC system, an overlap was noticed for pT2 and pT3 categories. Patients with stage IIIC disease had a similar prognosis to those with stage IV disease. The pT categories of the NET-AJCC system had a lower C-index and higher AIC than those of the other systems. In the ENETS system, there was a low proportion (0·2 per cent) of patients with stage IIIA and a high proportion (67·6 per cent) of stage IIIB disease. The mTNM system adopted the NET-AJCC pT and GC-AJCC pN and pM definitions, and was developed based on the ENETS stage definitions. The proportion of patients in each stage was better distributed and the mTNM system showed improved prognostic performance in predicting overall and disease-free survival. CONCLUSION: The mTNM system offers more accurate prognostic value for gastric (MA)NEC than the AJCC or ENETS staging systems.
Authors: Marcus Fernando Kodama Pertille Ramos; Marina Alessandra Pereira; Arthur Youssif Mota Arabi; Melissa Mello Mazepa; Andre Roncon Dias; Ulysses Ribeiro; Bruno Zilberstein; Sergio Carlos Nahas Journal: Med Sci (Basel) Date: 2021-06-25