Masaya Nakauchi1, Colin M Court1, Laura H Tang2, Mithat Gönen3, Yelena Y Janjigian4, Steven B Maron4, Daniela Molena5, Daniel G Coit1, Murray F Brennan1, Vivian E Strong1. 1. From the Gastric and Mixed Tumor Service, Department of Surgery (Nakauchi, Court, Coit, Brennan, Strong), Memorial Sloan Kettering Cancer Center, New York, NY. 2. Gastrointestinal Pathology Service, Department of Pathology (Tang), Memorial Sloan Kettering Cancer Center, New York, NY. 3. Department of Epidemiology and Biostatistics (Gönen), Memorial Sloan Kettering Cancer Center, New York, NY. 4. Gastrointestinal Oncology Service, Department of Medicine (Janjigian, Maron), Memorial Sloan Kettering Cancer Center, New York, NY. 5. Thoracic Service, Department of Surgery (Molena), Memorial Sloan Kettering Cancer Center, New York, NY.
Abstract
BACKGROUND: The Memorial Sloan Kettering Cancer Center (MSK) nomogram combined both gastroesophageal junction (GEJ) and gastric cancer patients and was created in an era from patients who generally did not receive neoadjuvant chemotherapy. We sought to reevaluate the MSK nomogram in the era of multidisciplinary treatment for GEJ and gastric cancer. STUDY DESIGN: Using data on patients who underwent R0 resection for GEJ or gastric cancer between 2002 and 2016, the C-index of prediction for disease-specific survival (DSS) was compared between the MSK nomogram and the American Joint Committee on Cancer (AJCC) 8th edition staging system after segregating patients by tumor location (GEJ or gastric cancer) and neoadjuvant treatment. A new nomogram was created for the group for which both systems poorly predicted prognosis. RESULTS: During the study period, 886 patients (645 gastric and 241 GEJ cancer) underwent up-front surgery, and 999 patients (323 gastric and 676 GEJ) received neoadjuvant treatment. Compared with the AJCC staging system, the MSK nomogram demonstrated a comparable C-index in gastric cancer patients undergoing up-front surgery (0.786 vs 0.753) and a better C-index in gastric cancer patients receiving neoadjuvant treatment (0.796 vs 0.698). In GEJ cancer patients receiving neoadjuvant chemotherapy, neither the MSK nomogram nor the AJCC staging system performed well (C-indices 0.647 and 0.646). A new GEJ nomogram was created based on multivariable Cox regression analysis and was validated with a C-index of 0.718. CONCLUSIONS: The MSK gastric cancer nomogram's predictive accuracy remains high. We developed a new GEJ nomogram that can effectively predict DSS in patients receiving neoadjuvant treatment.
BACKGROUND: The Memorial Sloan Kettering Cancer Center (MSK) nomogram combined both gastroesophageal junction (GEJ) and gastric cancer patients and was created in an era from patients who generally did not receive neoadjuvant chemotherapy. We sought to reevaluate the MSK nomogram in the era of multidisciplinary treatment for GEJ and gastric cancer. STUDY DESIGN: Using data on patients who underwent R0 resection for GEJ or gastric cancer between 2002 and 2016, the C-index of prediction for disease-specific survival (DSS) was compared between the MSK nomogram and the American Joint Committee on Cancer (AJCC) 8th edition staging system after segregating patients by tumor location (GEJ or gastric cancer) and neoadjuvant treatment. A new nomogram was created for the group for which both systems poorly predicted prognosis. RESULTS: During the study period, 886 patients (645 gastric and 241 GEJ cancer) underwent up-front surgery, and 999 patients (323 gastric and 676 GEJ) received neoadjuvant treatment. Compared with the AJCC staging system, the MSK nomogram demonstrated a comparable C-index in gastric cancer patients undergoing up-front surgery (0.786 vs 0.753) and a better C-index in gastric cancer patients receiving neoadjuvant treatment (0.796 vs 0.698). In GEJ cancer patients receiving neoadjuvant chemotherapy, neither the MSK nomogram nor the AJCC staging system performed well (C-indices 0.647 and 0.646). A new GEJ nomogram was created based on multivariable Cox regression analysis and was validated with a C-index of 0.718. CONCLUSIONS: The MSK gastric cancer nomogram's predictive accuracy remains high. We developed a new GEJ nomogram that can effectively predict DSS in patients receiving neoadjuvant treatment.
Authors: Alexander R Novotny; Christoph Schuhmacher; Raymonde Busch; Michael W Kattan; Murray F Brennan; Jörg Rüdiger Siewert Journal: Ann Surg Date: 2006-01 Impact factor: 12.969
Authors: J H Kim; H S Kim; W Y Seo; C M Nam; K Y Kim; H C Jeung; J F Lai; H C Chung; S H Noh; S Y Rha Journal: Ann Oncol Date: 2011-05-12 Impact factor: 32.976
Authors: Jaffer A Ajani; Thomas A D'Amico; David J Bentrem; Joseph Chao; Carlos Corvera; Prajnan Das; Crystal S Denlinger; Peter C Enzinger; Paul Fanta; Farhood Farjah; Hans Gerdes; Michael Gibson; Robert E Glasgow; James A Hayman; Steven Hochwald; Wayne L Hofstetter; David H Ilson; Dawn Jaroszewski; Kimberly L Johung; Rajesh N Keswani; Lawrence R Kleinberg; Stephen Leong; Quan P Ly; Kristina A Matkowskyj; Michael McNamara; Mary F Mulcahy; Ravi K Paluri; Haeseong Park; Kyle A Perry; Jose Pimiento; George A Poultsides; Robert Roses; Vivian E Strong; Georgia Wiesner; Christopher G Willett; Cameron D Wright; Nicole R McMillian; Lenora A Pluchino Journal: J Natl Compr Canc Netw Date: 2019-07-01 Impact factor: 11.908
Authors: Arnoud J Templeton; Mairéad G McNamara; Boštjan Šeruga; Francisco E Vera-Badillo; Priya Aneja; Alberto Ocaña; Raya Leibowitz-Amit; Guru Sonpavde; Jennifer J Knox; Ben Tran; Ian F Tannock; Eitan Amir Journal: J Natl Cancer Inst Date: 2014-05-29 Impact factor: 13.506
Authors: David Cunningham; William H Allum; Sally P Stenning; Jeremy N Thompson; Cornelis J H Van de Velde; Marianne Nicolson; J Howard Scarffe; Fiona J Lofts; Stephen J Falk; Timothy J Iveson; David B Smith; Ruth E Langley; Monica Verma; Simon Weeden; Yu Jo Chua Journal: N Engl J Med Date: 2006-07-06 Impact factor: 91.245
Authors: David Cunningham; Sally P Stenning; Elizabeth C Smyth; Alicia F Okines; William H Allum; Sam Rowley; Laura Stevenson; Heike I Grabsch; Derek Alderson; Thomas Crosby; S Michael Griffin; Wasat Mansoor; Fareeda Y Coxon; Stephen J Falk; Suzanne Darby; Kate A Sumpter; Jane M Blazeby; Ruth E Langley Journal: Lancet Oncol Date: 2017-02-03 Impact factor: 41.316