A novel TNM staging system for gastric cancer based on the metro-ticket paradigm

a comparative study with the AJCC-TNM staging system

Jun Lu, Zhi Fang Zheng, Wei Wang, Jian Wei Xie, Jia Bin Wang, Jian Xian Lin, Qi Yue Chen, Long Long Cao, Mi Lin, Ru Hong Tu, Zhi-Wei Zhou, Chang Ming Huang, Chao Hui Zheng, Ping Li

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). Methods: The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. Results: nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. Conclusion: Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.

Original languageEnglish (US)
Pages (from-to)759-768
Number of pages10
JournalGastric Cancer
Volume22
Issue number4
DOIs
StatePublished - Jul 12 2019

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Neoplasm Staging
Stomach Neoplasms
Survival
Solar System
Hepatocellular Carcinoma
Epidemiology
Databases
Neoplasms

Keywords

  • AJCC
  • Gastric cancer
  • Metro-ticket
  • TNM staging system

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

A novel TNM staging system for gastric cancer based on the metro-ticket paradigm : a comparative study with the AJCC-TNM staging system. / Lu, Jun; Zheng, Zhi Fang; Wang, Wei; Xie, Jian Wei; Wang, Jia Bin; Lin, Jian Xian; Chen, Qi Yue; Cao, Long Long; Lin, Mi; Tu, Ru Hong; Zhou, Zhi-Wei; Huang, Chang Ming; Zheng, Chao Hui; Li, Ping.

In: Gastric Cancer, Vol. 22, No. 4, 12.07.2019, p. 759-768.

Research output: Contribution to journalArticle

Lu, J, Zheng, ZF, Wang, W, Xie, JW, Wang, JB, Lin, JX, Chen, QY, Cao, LL, Lin, M, Tu, RH, Zhou, Z-W, Huang, CM, Zheng, CH & Li, P 2019, 'A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system', Gastric Cancer, vol. 22, no. 4, pp. 759-768. https://doi.org/10.1007/s10120-018-00904-w
Lu, Jun ; Zheng, Zhi Fang ; Wang, Wei ; Xie, Jian Wei ; Wang, Jia Bin ; Lin, Jian Xian ; Chen, Qi Yue ; Cao, Long Long ; Lin, Mi ; Tu, Ru Hong ; Zhou, Zhi-Wei ; Huang, Chang Ming ; Zheng, Chao Hui ; Li, Ping. / A novel TNM staging system for gastric cancer based on the metro-ticket paradigm : a comparative study with the AJCC-TNM staging system. In: Gastric Cancer. 2019 ; Vol. 22, No. 4. pp. 759-768.
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abstract = "Background: The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). Methods: The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. Results: nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0{\%} (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2{\%} (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. Conclusion: Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.",
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author = "Jun Lu and Zheng, {Zhi Fang} and Wei Wang and Xie, {Jian Wei} and Wang, {Jia Bin} and Lin, {Jian Xian} and Chen, {Qi Yue} and Cao, {Long Long} and Mi Lin and Tu, {Ru Hong} and Zhi-Wei Zhou and Huang, {Chang Ming} and Zheng, {Chao Hui} and Ping Li",
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T1 - A novel TNM staging system for gastric cancer based on the metro-ticket paradigm

T2 - a comparative study with the AJCC-TNM staging system

AU - Lu, Jun

AU - Zheng, Zhi Fang

AU - Wang, Wei

AU - Xie, Jian Wei

AU - Wang, Jia Bin

AU - Lin, Jian Xian

AU - Chen, Qi Yue

AU - Cao, Long Long

AU - Lin, Mi

AU - Tu, Ru Hong

AU - Zhou, Zhi-Wei

AU - Huang, Chang Ming

AU - Zheng, Chao Hui

AU - Li, Ping

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N2 - Background: The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). Methods: The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. Results: nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. Conclusion: Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.

AB - Background: The metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC). Methods: The nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n = 4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n = 1800) and Surveillance, Epidemiology, and End Results (SEER) (n = 3227) databases. Results: nTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n = 2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n = 1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P < 0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P < 0.001) compared to the 7th and 8th editions (P = 0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts. Conclusion: Compared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.

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