Different prognostic implication of ypTNM stage and pTNM stage for gastric cancer: a propensity score-matched analysis.
Gastric cancer
Neoadjuvant chemotherapy
Propensity score matching
Survival
pTNM
ypTNM
Journal
BMC cancer
ISSN: 1471-2407
Titre abrégé: BMC Cancer
Pays: England
ID NLM: 100967800
Informations de publication
Date de publication:
16 Jan 2019
16 Jan 2019
Historique:
received:
20
06
2018
accepted:
07
01
2019
entrez:
18
1
2019
pubmed:
18
1
2019
medline:
30
4
2019
Statut:
epublish
Résumé
Pathological stage is considered as the best prognosis indicator for gastric cancer. With the increasing use of neoadjuvant chemotherapy (NACT), the latest TNM staging included a new pathological stage of ypTNM for patients with NACT. However, no study has investigated if ypTNM stage has the same prognostic implication as pTNM stage for gastric cancer. We retrospectively selected eligible patients within a prospectively maintained database containing all patients treated with gastric cancer in Peking University Cancer Hospital from 2007 to 2015 using overall survival as the outcome. Patients using ypTNM and pTNM were 1:1 matched by propensity scores (PS) calculated from a model containing variables associated with ypTNM use or survival. Overall survival was compared by unconditional Cox regression. Conventional multivariate analysis was conducted to corroborate PS matching results. 1441 patients were included in the analysis with a median follow-up of 37 months (range = 2-106). The matched sample contained 756 patients. After PS matching, patients with specific ypTNM stage were 1.34 (95%CI = 1.05-1.72, P = 0.019) times more likely to die than patients with the same pTNM stage. Similar to the results of PS matching, multivariate Cox regression yielded a hazard ratio (HR) of 1.35 (95%CI = 1.09-1.67, P = 0.006). Subgroup analysis indicated this survival difference between ypTNM and pTNM stage varied by the specific TNM stage of patients. The HR was 3.44 (95%CI = 1.06-11.18, P = 0.040) and 1.28 (95%CI = 1.00-1.62, P = 0.048) for patients in stage I and III, respectively; whereas for stage II patients, no significant difference was observed (HR = 1.37, 95%CI = 0.78-2.38, P = 0.27). Gastric cancer patients with specific ypTNM stage had worse prognosis compared to those at the same stage defined by pTNM.
Sections du résumé
BACKGROUND
BACKGROUND
Pathological stage is considered as the best prognosis indicator for gastric cancer. With the increasing use of neoadjuvant chemotherapy (NACT), the latest TNM staging included a new pathological stage of ypTNM for patients with NACT. However, no study has investigated if ypTNM stage has the same prognostic implication as pTNM stage for gastric cancer.
METHODS
METHODS
We retrospectively selected eligible patients within a prospectively maintained database containing all patients treated with gastric cancer in Peking University Cancer Hospital from 2007 to 2015 using overall survival as the outcome. Patients using ypTNM and pTNM were 1:1 matched by propensity scores (PS) calculated from a model containing variables associated with ypTNM use or survival. Overall survival was compared by unconditional Cox regression. Conventional multivariate analysis was conducted to corroborate PS matching results.
RESULTS
RESULTS
1441 patients were included in the analysis with a median follow-up of 37 months (range = 2-106). The matched sample contained 756 patients. After PS matching, patients with specific ypTNM stage were 1.34 (95%CI = 1.05-1.72, P = 0.019) times more likely to die than patients with the same pTNM stage. Similar to the results of PS matching, multivariate Cox regression yielded a hazard ratio (HR) of 1.35 (95%CI = 1.09-1.67, P = 0.006). Subgroup analysis indicated this survival difference between ypTNM and pTNM stage varied by the specific TNM stage of patients. The HR was 3.44 (95%CI = 1.06-11.18, P = 0.040) and 1.28 (95%CI = 1.00-1.62, P = 0.048) for patients in stage I and III, respectively; whereas for stage II patients, no significant difference was observed (HR = 1.37, 95%CI = 0.78-2.38, P = 0.27).
CONCLUSION
CONCLUSIONS
Gastric cancer patients with specific ypTNM stage had worse prognosis compared to those at the same stage defined by pTNM.
Identifiants
pubmed: 30651085
doi: 10.1186/s12885-019-5283-3
pii: 10.1186/s12885-019-5283-3
pmc: PMC6335703
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
80Subventions
Organisme : Beijing Health Bureau
ID : 2013-3-085
Organisme : Ministry of Science and Technology of the People's Republic of China
ID : 2014BAI09B02
Organisme : Beijing Municipal Science & Technology Commission
ID : Z151100004015070
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