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Gastric Cancer. 2019 Jul;22(4):759-768. doi: 10.1007/s10120-018-00904-w. Epub 2019 Jan 5.

A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system.

Lu J1,2, Zheng ZF1,2, Wang W3, Xie JW1,2, Wang JB1,2,3,4, Lin JX1,2,3,4, Chen QY1,2, Cao LL1,2, Lin M1,2, Tu RH1,2, Zhou ZW5, Huang CM6,7,8,9, Zheng CH10,11,12,13, Li P14,15,16,17.

Author information

1
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China.
2
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
3
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
4
Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China.
5
Department of Gastric Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, China. zhouzhw@sysucc.org.cn.
6
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. hcmlr2002@163.com.
7
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. hcmlr2002@163.com.
8
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. hcmlr2002@163.com.
9
Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. hcmlr2002@163.com.
10
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. wwkzch@163.com.
11
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. wwkzch@163.com.
12
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. wwkzch@163.com.
13
Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. wwkzch@163.com.
14
Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, 350001, Fujian Province, China. pingli811002@163.com.
15
Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China. pingli811002@163.com.
16
Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China. pingli811002@163.com.
17
Fujian Key Laboratory of Tumor Microbiology, Fujian Medical University, Fuzhou, China. pingli811002@163.com.

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.

KEYWORDS:

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

PMID:
30612230
DOI:
10.1007/s10120-018-00904-w

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