Which staging system better predicts 10-year survival for gastric cancer? A study using an international multicenter...

Our aim was to evaluate the prognostic performance of the 8th edition AJCC staging system for gastric cancer survival after 10 years or more.

An international multicenter database was constructed (total n = 4537) by combining gastric cancer cases from the SEER database (n = 3066) and the database (n = 1471) of the Department of Gastric Surgery, Fujian Medical University Union Hospital. The relative discriminatory abilities were assessed using the likelihood ratio chi-square test, Akaike's Information Criterion (AIC) and Harrell's concordance index (c-statistic).

The 10-year overall survival rate for all the patients was 32.2%. A 2-step multivariate analysis showed that the 8th edition staging system was an independent factor for long-term overall survival. It also had higher likelihood ratio chi-square score, c-statistic and smaller AIC values compared with the 7th edition. However, stages IB and IIA of the TNM staging system showed a similar prognosis (both P > 0.05). Based on the survival data, we revised the 8th edition by merging stages IB and IIA into 1 category in the training set. The modified staging system demonstrated superior prognostic stratification with a higher c-statistic, likelihood ratio chi-square score and smaller AIC values compared to the 8th edition. Similar results were observed in the external validation set.

The 8th edition AJCC TNM classification predicts the 10-year survival of gastric cancer patients more accurately than the 7th edition. However, by merging stages IB and IIA into 1 category, we propose a revised TNM stage system that provides an optimal prognosis.