AUTHOR=Zhang Miaoquan , Ding Chao , Xu Lin , Ou Biyi , Feng Shoucheng , Wang Guoqiang , Wang Wei , Liang Yao , Chen Yingbo , Zhou Zhiwei , Qiu Haibo 

TITLE=Comparison of a Tumor-Ratio–Metastasis Staging System and the 8th AJCC TNM Staging System for Gastric Cancer

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.595421

DOI=10.3389/fonc.2021.595421

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>Despite the implementation of the 8th American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer (GC) in 2017, it still holds a significant level of stage migration which affects patients’ proper classification and accurate prognosis. Here, to reduce this effect, we evaluated the prognostic value of a lymph node ratio (LNR) and established a novel tumor–ratio–metastasis (TRM) staging system.</p></sec><sec><title>Method</title><p>The data of 15,206 GC patients from the Sun Yat-sen University Cancer Center (Training set; n=2,032) and the US Surveillance, Epidemiology, and End Results (SEER) database (Validation set; n=13,174) were analyzed. The training set was classified into 5 LNR categories, based on which the novel TRM staging system was constructed. The overall survival (OS) between the TRM and AJCC TNM systems was compared in the training set and validated in the validation set. The likelihood ratio <italic>x</italic><sup>2</sup>, liner trend <italic>x</italic><sup>2</sup>, C-index, and Akaike information criterion (AIC) values were used to measure the discriminatory ability between the two different staging systems. Decision curve analyses (DCAs) were conducted to test the clinical value of the two staging systems.</p></sec><sec><title>Result</title><p>The patients were classified into the following categories: LNR0: 0%, LNR1: 0%&lt;LNR ≤ 10%, LNR2: 10%&lt;LNR ≤ 25%, LNR 3a: 25%&lt;LNR ≤ 60%, and LNR 3b: LNR&gt;60%. Univariate analyses demonstrated that the log-rank <italic>x</italic><sup>2</sup> of the LNR stage (Training/Validation set: <italic>x</italic><sup>2</sup> = 463.1/2880.8) was larger than the AJCC pN stage (Training/Validation set: <italic>x</italic><sup>2</sup> = 281.5/2240.8). For both the training set and validation set, stratified analyses using the Kaplan-Meier method identified significantly heterogeneous OS in every pN category but only one using the LNR. The TRM staging system had higher likelihood ratio <italic>x</italic><sup>2</sup>, liner trend <italic>x</italic><sup>2</sup>, C-index and smaller AIC values than the TNM system.</p></sec><sec><title>Conclusion</title><p>The TRM staging system demonstrated improved homogeneity and discriminatory ability in predicting the prognosis of GC patients compared with the AJCC TNM staging system.</p></sec>