Providing Reliable Prognosis to Patients with Gastric Cancer in the Era of Neoadjuvant Therapies: Comparison of AJCC Staging Schemata.
Gastric cancer
Outcomes research
Prognosis
Stomach
Survival
Journal
Journal of gastric cancer
ISSN: 2093-582X
Titre abrégé: J Gastric Cancer
Pays: Korea (South)
ID NLM: 101559430
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
received:
31
08
2020
accepted:
23
10
2020
entrez:
11
1
2021
pubmed:
12
1
2021
medline:
12
1
2021
Statut:
ppublish
Résumé
Patients with gastric cancer who receive neoadjuvant therapy are staged before treatment (cStage) and after treatment (ypStage). We aimed to compare the prognostic reliability of cStage and ypStage, alone and in combination. Data for all patients who received neoadjuvant therapy followed by surgery for gastric adenocarcinoma from 2004 to 2015 were extracted from the National Cancer Database. Kaplan-Meier (KM)curves were used to model overall survival based on cStage alone, ypStage alone, cStage stratified by ypStage, and ypStage stratified by cStage. P-values were generated to summarize the differences in KM curves. The discriminatory power of survival prediction was examined using Harrell's C-statistics. We included 8,977 patients in the analysis. As expected, increasing cStage and ypStage were associated with worse survival. The discriminatory prognostic power provided by cStage was poor (C-statistic 0.548), while that provided by ypStage was moderate (C-statistic 0.634). Within each cStage, the addition of ypStage information significantly altered the prognosis (P<0.0001 within cStages I-IV). However, for each ypStage, the addition of cStage information generally did not alter the prognosis (P=0.2874, 0.027, 0.061, 0.049, and 0.007 within ypStages 0-IV, respectively). The discriminatory prognostic power provided by the combination of cStage and ypStage was similar to that of ypStage alone (C-statistic 0.636 vs. 0.634). The cStage is unreliable for prognosis, and ypStage is moderately reliable. Combining cStage and ypStage does not improve the discriminatory prognostic power provided by ypStage alone. A ypStage-based prognosis is minimally affected by the initial cStage.
Identifiants
pubmed: 33425440
doi: 10.5230/jgc.2020.20.e41
pmc: PMC7781744
doi:
Types de publication
Journal Article
Langues
eng
Pagination
385-394Subventions
Organisme : NCI NIH HHS
ID : T32 CA200561
Pays : United States
Informations de copyright
Copyright © 2020. Korean Gastric Cancer Association.
Déclaration de conflit d'intérêts
Conflict of Interest: No potential conflict of interest relevant to this article was reported.
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