Modified gastric cancer ypTNM staging based on optimized lymph node staging: A large-sample, international
Bao-Long Li1, Ru-Hong Tu2, Qing Zhong2
1Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, The Fifth Affiliated Hospital, Southern Medical University, Guangzhou, China; Key Laboratory of Ministry of Education of Gastrointestinal Cancer, Fujian Medical, University, Fuzhou, China.
Summary
A new modified ypTNM staging system for gastric cancer (GC) after neoadjuvant therapy (NAT) shows improved prognostic accuracy over the AJCC 8th Edition. This enhanced system offers a more precise tool for clinical decision-making in GC patients post-NAT.
Area of Science:
- Oncology
- Surgical Oncology
- Cancer Staging
Background:
- The AJCC 8th Edition ypTNM staging system's prognostic accuracy for gastric cancer (GC) post-neoadjuvant therapy (NAT) is debated.
- Accurate staging is crucial for treatment planning and predicting outcomes in locally advanced GC.
Purpose of the Study:
- To develop and validate a novel ypTNM staging system for GC patients who received NAT.
- To compare the prognostic performance of the modified system against the current AJCC 8th Edition standard.
Main Methods:
- Retrospective analysis of 1078 locally advanced GC patients who underwent NAT at international multicenter institutions.
- Optimization of lymph node staging (ypN) based on overall survival (OS) and disease-specific survival (DSS).
- Development and validation of a novel ypTNM staging system, including external validation using US-based databases.
Main Results:
- The modified ypN category demonstrated superior prognostic discrimination and significant differences in OS and DSS compared to standard cut-offs.
- The new ypTNM system showed improved accuracy (C-index), model fit, clinical utility (NRI, II), and stability compared to the AJCC 8th Edition.
- External validation confirmed the superiority of the modified staging system (all p<0.05).
Conclusions:
- An internationally validated, modified ypTNM system based on optimized lymph node staging offers superior prognostic accuracy for GC patients post-NAT.
- This novel system provides a more precise tool for clinical decision-making compared to the AJCC 8th Edition.
