alexa Validating the prognostic and discriminating value of the TNM-classification for gastric cancer - a critical appraisal.
Medicine

Medicine

Evidence based Medicine and Practice

Author(s): Rcken C, Behrens HM

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Abstract AIM: We investigated the effect of the new tumour-, node-, metastasis- (TNM) classification on predicting and discriminating gastric cancer patient prognosis using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program. PATIENTS AND METHODS: From the SEER-database we retrieved gastric cancer patients with a primary adenocarcinoma, of Caucasian or Asian ethnicity and without distant metastases (M0). The pTNM-stage was determined according to the 7th edition of the union internationale contre le cancer (UICC) guidelines. RESULTS: Spanning the period 2004-2010, 6136 patients fulfilled all inclusion criteria including 3424 (55.8\%) men, 2712 (44.2\%) women, 4629 (75.4\%) Caucasian and 1507 (24.6\%) Asian patients. 1524 (24.8\%) patients underwent total gastrectomy and 4612 (75.2\%) non-total gastrectomy. Only in 41.2\% of the patients were >15 lymph nodes resected. 1857 (31.0\%) patients received radiotherapy. Patient survival depended on ethnicity, type of surgery and radiotherapy. The discriminating value of the UICC-stage grouping could not be validated for Caucasian patients with >15 lymph nodes resected and who had not received radiotherapy: stage groups IIB, IIIA, IIIB and IIIC showed substantial overlap in survival ranges. In addition, the tumour specific survival of the different T-/N-combinations was significantly different in stage groups IIIB and IIIC, respectively. CONCLUSIONS: Our retrospective analysis of the SEER-database does not validate the discriminating value of stage grouping of the 7th edition of the UICC-stage grouping. A revision should be considered and more reliable prognostic biomarkers are urgently needed. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved. This article was published in Eur J Cancer and referenced in Evidence based Medicine and Practice

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