Gastric cancer is the second leading cause of cancer death worldwide; the risk of dying depends on several patient and disease characteristics. An existing prognostic score predicts survival in gastric cancer patients undergoing curative resection based on patient age, tumor site, extent of wall invasion and nodal status, categorized as simply as negative or positive.
Methods
Our aim was to modify the original prognostic score by incorporating information on nodal stage according to the latest TNM classification (number of involved nodes), based on a retrospective series of 610 chemotherapy-naïve gastric cancer patients recruited to a surgical clinical trial. We then tested the modified score on an independent series of 136 gastric cancer patients.
Results
Nodal stage added significant prognostic information to the nodal status classification (P <0.001), and was therefore included in the modified score. With the latter, we were able to identify three risk groups with overall five-year survival varying from more than 70% to less than 30%. The prognostic performance of the modified score was better than that achieved with the AJCC-UICC TNM staging.
Conclusions
The modified score, based on established prognostic factors, is proposed as a simple tool for prognostic grouping of gastric cancer patients undergoing curative surgery.
MarubiniE., BonfantiG., BozzettiF., BoracchiP., AmadoriD., FolliS., NanniO., GennariL.: A prognostic score for patients resected for gastric cancer. Eur J Cancer, 29A: 845–850, 1993.
2.
HermanekP.: The superiority of the new International Union Against Cancer and American Joint Committee on cancer TNM staging of gastric carcinoma. Cancer, 88: 1763–1765, 2000.
3.
MarubiniE., BozzettiF., MiceliR., BonfantiG., GennariL.: Gastrointestinal Tumor Study Group. Lymphadenectomy in gastric cancer: prognostic role and therapeutic implications. Eur J Surg Oncol, 28: 406–412, 2002.
4.
SobinL.H., WittekindC.H.: International Union Against Cancer (UICC) TNM classification of malignant tumors. 5th 59–62, John Wiley & Sons, New York, 1997.
5.
BozzettiF., MarubiniE., BonfantiG., MiceliR., PianoC., GennariL.: Subtotal versus total gastrectomy for gastric cancer: five-year survival rates in a multicenter randomized Italian trial. Ann Surg, 230: 170–178, 1999.
6.
The Italian Gastrointestinal Tumor Study Group:Adjuvant treatments following curative resection for gastric cancer. Br J Surg, 75: 1100–1104, 1988.
7.
NakajimaT., KajitaniT.: Surgical treatment of gastric cancer with special reference to lymph node dissection. In: Proc Int Cong. Diagnosis and treatment of upper gastrointestinal tumors. Excerpta Med, 207–225, Elsevier, Amsterdam, 1980.
8.
BajettaE., BuzzoniR., MarianiL., BerettaE., BozzettiF., BordognaG., AitiniE., FavaS., SchieppatiG., PinottiG., VisiniM., IannielloG., Di BartolomeoM.: Adjuvant chemotherapy in gastric cancer: 5-year results of a randomized study by the Italian Trials in Medical Oncology (ITMO Group). Ann Oncol, 13: 299–307, 2002.
9.
Van HouwelingenH.C., ThorogoodJ.: Construction, validation and updating of a prognostic model for kidney graft survival. Stat Med, 14: 1999–2008, 1995.
10.
Van HouwelingenH.C.: Validation, calibration, revision and combination of prognostic survival models. Stat Med, 19: 3401–3415, 2000.
11.
LaurénP.: The two main types of gastric carcinoma: diffuse and so-called intestinal type carcinoma. APMIS, 64: 31–49, 1965.
12.
EfronB., TibshiraniR.J.: An introduction to the bootstrap.Chapman & Hall, New York, 1993.
13.
Van HouvelingenH.C., le CessieS.: Predictive value of statistical models. Stat Med, 9: 1303–1325, 1990.
14.
BeggC.B., CramerL.D., VenkatramanE.S., RosaiJ.: Comparing tumor staging and grading systems: a case study and a review of the issues, using thymoma as a model. Stat Med, 19: 1997–2014, 2000.
15.
MiceliR., LusaL., MarianiL.: Revising a prognostic index developed for classification purposes: an application to gastric cancer data. J Appl Stat, 31: 817–830, 2004.
16.
SAS Institute:SAS/STAT’ User's Guide.Cary, NC, 1990.
TerryM.B., GaudetM.M., GammonM.D.: The epidemiology of gastric cancer. Semin Radiat Oncol, 12: 111–127, 2002.
19.
Japanese Research Society for Gastric Cancer.Japanese Classification of Gastric Carcinoma.Kanehara, Tokyo, 1995.
20.
HermanekP., Altendorf-HoffmannA., MansumannU., DworakO., WittekindC., HohenbergerW.: Improvements in staging of gastric carcinoma from using the new edition of TNM classification. Eur J Surg Oncol, 24: 536–541, 1998.
21.
RoderJ.D., BottcherK., BushR., WittekindC., HermanekP., SiewertJ.R.: Classification of regional lymph node metastasis from gastric carcinoma. Cancer, 82: 621–631, 1998.
22.
YooC.H., NohS.H., KimY.I., MinJ.S.: Comparison of prognostic significance of nodal staging between old (4th edition) and new (5th edition) UICC TNM classification for gastric carcinoma. World J Surg, 23: 492–498, 1999.
23.
KataiH., YoshimuraK., MaruyamaK., SasakoM., SanoT.: Evaluation of the new International Union Against Cancer TNM staging for gastric carcinoma. Cancer, 88: 1796–1800, 2000.
24.
KranenbargE.K., HermansJ., van KriekenJ.H., van de VeldeC.J.H.: Evaluation of the 5th edition of the TNM classsification for gastric cancer: improved prognostic value. Br J Cancer, 84: 64–71, 2001.
25.
MsikaS., BenhamicheA.M., JouveJ.L., RatP., FaivreJ.: Prognostic factors after curative resection for gastric cancer. A population-based study. Eur J Cancer, 36: 390–396, 2000.
26.
BurkeE.C., KarpehM.S.J., KonlonK.C., BrennanM.F.: Peritoneal lavage cytology in gastric cancer: an independent predictor of outcome. Ann Surg Oncol, 5: 411–415, 1998.
27.
VictorzonM., LundinJ., HaglundC., NordlingS., RobertsP.J.: A risk score for predicting outcome in patients with gastric cancer, based on stage, sialyl-Tn immunoreactivity and ploidy. A multivariate analysis. Int J Cancer, 67: 190–193, 1996.
28.
Sanchez-BuenoF., Garcia-MarcillaJ.A., Perez-FloresD., Perez-AbadJ.M., VicenteR., ArandaF., RamirezP., ParrillaP.: Prognostic factors in a series of 297 patients with gastric adenocarcinoma undergoing surgical resection. Br J Surg, 85: 255–260, 1998.
29.
KologluM., KamaN.A., ReisE., DoganayM., AtliM., DolapciM.A.: prognostic score for gastric cancer. Am J Surg, 179: 521–526, 2000.
30.
KattanM.W., KarpehM.S., MazumdarM., BrennanM.F.: Postoperative nomogram for disease-specific survival after an R0 resection for gastric carcinoma. J Clin Oncol, 21: 3647–3650, 2003.
31.
OtsujiE., YamaguchiT., SawaiK., HagiwaraA., TaniguchiH., TakahashiT.: Recent advances in surgical treatment have improved the survival of patients with gastric carcinoma. Cancer, 82: 1233–1237, 1998.
32.
BorchK., JonssonB., TarpilaE., FranzenT., BerglundT.F.J., KullmanE., FranzenL.: Changing pattern of histological type, location, stage and outcome of surgical treatment of gastric carcinoma. Br J Surg, 87: 618–626, 2000.
33.
FeinsteinA.R., SosinD.M., WellsC.K.: The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med, 312: 1604–1608, 1985.
34.
HermansJ., BonenkampJ.J., BoonM.C., BuntA.M., OhyamaS., SasakoM., Van de VeldeC.J.: Adjuvant therapy after curative resection for gastric cancer: meta-analysis of randomized trials. J Clin Oncol, 11: 1441–1447, 1993.
35.
HermansJ., BonenkampJ.J.: Reply to correspondence by Pignon, Ducreux and Rougier and Piedbois and Buyse. J Clin Oncol, 12: 877–880, 1994.
36.
EarleC.C., MarounJ.A.: Adjuvant chemotherapy after curative resection for gastric cancer in non-Asian patients: revisiting a meta-analysis of randomised trials. Eur J Cancer, 35: 1059–1064, 1999.
37.
MariE., FlorianiI., TinazziA., BudaA., BelfiglioM., ValentiniM., CascinuS., BarniS., LabiancaR., TorriV.: Efficacy of adjuvant chemotherapy after curative resection for gastric cancer: a meta-analysis of published randomised trial. Ann Oncol, 11: 837–843, 2000.
