Modification of the TNM Staging System for Stage II/III Gastric Cancer Based on a Prognostic Single Patient Classifier Algorithm

최윤영; 장은지; 서원준; 손태일; 김형일; 김혜선; 형우진; 허용민; 노성훈; 정재호

doi:https://doi.org/10.5230/jgc.2018.18.e14

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자료유형: 학술저널

저자정보: 최윤영 (연세대학교) 장은지 ((주) 노보믹스메디텍) 서원준 (연세대학교) 손태일 (연세대학교) 김형일 (연세대학교) 김혜선 ((주) 노보믹스메디텍) 형우진 (연세대학교) 허용민 (연세대학교) 노성훈 (연세대학교) 정재호 (연세대학교)

저널정보: 대한위암학회 Journal of Gastric Cancer Journal of Gastric Cancer 제18권 제2호

발행연도: 2018.6

수록면: 142 - 151 (10page)

DOI: https://doi.org/10.5230/jgc.2018.18.e14

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Purpose: The modification of the cancer classification system aimed to improve the classical anatomy-based tumor, node, metastasis (TNM) staging by considering tumor biology, which is associated with patient prognosis, because such information provides additional precision and flexibility. Materials and Methods: We previously developed an mRNA expression-based single patient classifier (SPC) algorithm that could predict the prognosis of patients with stage II/III gastric cancer. We also validated its utilization in clinical settings. The prognostic single patient classifier (pSPC) differentiates based on 3 prognostic groups (low-, intermediate-, and high-risk), and these groups were considered as independent prognostic factors along with TNM stages. We evaluated whether the modified TNM staging system based on the pSPC has a better prognostic performance than the TNM 8th edition staging system. The data of 652 patients who underwent gastrectomy with curative intent for gastric cancer between 2000 and 2004 were evaluated. Furthermore, 2 other cohorts (n=307 and 625) from a previous study were assessed. Thus, 1,584 patients were included in the analysis. To modify the TNM staging system, one-grade down-staging was applied to low-risk patients according to the pSPC in the TNM 8th edition staging system; for intermediate- and high-risk groups, the modified TNM and TNM 8th edition staging systems were identical. Results: Among the 1,584 patients, 187 (11.8%), 664 (41.9%), and 733 (46.3%) were classified into the low-, intermediate-, and high-risk groups, respectively, according to the pSPC. pSPC prognoses and survival curves of the overall population were well stratified, and the TNM stage-adjusted hazard ratios of the intermediate- and high-risk groups were 1.96 (95% confidence interval [CI], 1.41?2.72; P<0.001) and 2.54 (95% CI, 1.84?3.50; P<0.001), respectively. Using Harrell's C-index, the prognostic performance of the modified TNM system was evaluated, and the results showed that its prognostic performance was better than that of the TNM 8th edition staging system in terms of overall survival (0.635 vs. 0.620, P<0.001). Conclusions: The pSPC-modified TNM staging is an alternative staging system for stage II/III gastric cancer.

#Classification #gastric cancer #staging #prognosis #biomarker

참고문헌 (17)

참고문헌 신청

Union for International Cancer Control / 0000 / What is TNM? [Internet]

Brierley JD / 2002 / Accuracy of recorded tumor, node, and metastasis stage in a comprehensive cancer center / J Clin Oncol 20:413~419

Amin MB / 2017 / AJCC Cancer Staging Manual / Springer

Ferlay J / 2015 / Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012 / Int J Cancer 136:E359~E386

Cancer Genome Atlas Research Network / 2014 / Comprehensive molecular characterization of gastric adenocarcinoma / Nature 513:202~209

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