Open AccessModified ypTNM Staging Classification for Gastric Cancer after Neoadjuvant Therapy: A Multi‐Institutional Study
Author(s) -
Zhong Qing,
Chen QiYue,
Parisi Amilcare,
Ma YuBin,
Lin GuangTan,
Desiderio Jacopo,
Yan Su,
Xie JianWei,
Wang JiaBin,
Hou JunFang,
Lin JianXian,
Lu Jun,
Cao LongLong,
Lin Mi,
Tu RuHong,
Huang ZeNing,
Lin JuLi,
Liu ZhiYu,
Que SiJin,
Li Ping,
Zheng ChaoHui,
Huang ChangMing
Publication year - 2021
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2020-0022
Subject(s) - medicine , neoadjuvant therapy , receiver operating characteristic , surveillance, epidemiology, and end results , cancer , oncology , cohort , stage (stratigraphy) , gastrectomy , surgery , cancer registry , breast cancer , paleontology , biology
Background The benefits of neoadjuvant therapy for patients with locally advanced gastric cancer (GC) are increasingly recognized. The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. This study aims to develop a modified ypTNM staging. Patients and Methods Clinicopathological data of 1,791 patients who underwent curative‐intent gastrectomy after neoadjuvant therapy in the Surveillance, Epidemiology, and End Results database, as the development cohort, were retrospectively analyzed. Modified ypTNM staging was established based on overall survival (OS). We compared the prognostic performance of the AJCC 8th edition ypTNM staging and the modified staging for patients after neoadjuvant therapy. Results In the development cohort, the 5‐year OS for AJCC stages I, II, and III was 58.8%, 39.1%, and 21.6%, respectively, compared with 69.9%, 54.4%, 34.4%, 24.1%, and 13.6% for modified ypTNM stages IA, IB, II, IIIA, and IIIB. The modified staging had better discriminatory ability (C‐index: 0.620 vs. 0.589, p < .001), predictive homogeneity (likelihood ratio chi‐square: 140.71 vs. 218.66, p < .001), predictive accuracy (mean difference in Bayesian information criterion: 64.94; net reclassification index: 35.54%; integrated discrimination improvement index: 0.032; all p < .001), and model stability (time‐dependent receiver operating characteristics curves) over AJCC. Decision curve analysis showed that the modified staging achieved a better net benefit than AJCC. In external validation ( n = 266), the modified ypTNM staging had superior prognostic predictive power (all p < .05). Conclusion We have developed and validated a modified ypTNM staging through multicenter data that is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with GC after neoadjuvant therapy. Implications for Practice The 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual first proposed ypTNM staging, but its accuracy is controversial. Based on multi‐institutional data, this study developed a modified ypTNM staging, which is superior to the AJCC 8th edition ypTNM staging, allowing more accurate assessment of the prognosis of patients with gastric cancer after neoadjuvant therapy.