Comparison between gastric and esophageal classification system among adenocarcinomas of esophagogastric junction according to AJCC 8th edition: a retrospective observational study from two high-volume institutions in China.
机构：[1]Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu 610041, Sichuan, China四川大学华西医院[2]Division of Digestive Surgery, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi’an 710032, Shanxi, China[3]West China School of Medicine, Sichuan University, Chengdu, Sichuan, China四川大学华西医院[4]Department of Gastrointestinal Surgery and Laboratory of Digestive Surgery, Institute of Digestive Surgery and State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu 610041, Sichuan, China四川大学华西医院
The new 8th TNM system attributes AEG Siewert type II to esophageal classification system. However, the gastric and esophageal classification system which was more suitable for type II remains in disputation. This study aimed to illuminate the 8th TNM-EC or TNM-GC system which was more rational for type II, especially for patients underwent transhiatal approaches.
We collected the database of patients with AEG who underwent radical surgical resection from two high-volume institutions in China: West China Hospital (N = 773) and Xi Jing Hospital of Fourth Military University (N = 637). The cases were randomly matched into 705 training cohort and 705 validation cohort. All the cases were reclassified by the 8th edition of TNM-EC and TNM-GC. The distribution of patients in each stage, the hazard ratio of each stage, and the separation of the survival were compared. Multivariate analysis was performed using the Cox proportional hazard model. Comparisons between the different staging systems for the prognostic prediction were performed with the rcorrp.cens package in Hmisc in R (version 3.4.4. http://www.R-project.org/ ). The validity of these two systems was evaluated by Akaike information criterion (AIC) and concordance index (C-index).
By univariate analysis, the HRs from stage IA/IB to stage IV/IVB were monotonously increased according to TNM-GC scheme in both cohorts (training 2.63, 3.91, 5.02, 8.64, 15.51 and 29.64; validation 1.54, 3.55, 4.91, 7.14, 11.67, 18.71 and 48.32) whereas only a fluctuating increased tendency was found when staged by TNM-EC. After the multivariate analysis, TNM-GC (P < 0.001), TNM-EC (P = 0.001) in training cohort and TNM-GC (P < 0.001) TNM-EC (P < 0.001) in the validation cohort were both independent prognostic factors. The C-index value for the TNM-GC scheme was larger than that of TNM-EC system in both training (0.721 vs. 0.690, P < 0.001) and validation (0.721 vs. 0.696, P < 0.001) cohorts. After stratification analysis for Siewert type II, the C-index for TNM-GC scheme was still larger than that of TNM-EC in both training (0.724 vs. 0.694, P = 0.005) and validation (0.723 vs. 0.699, P < 0.001) cohorts.
The 8th TNM-GC scheme is superior to TNM-EC in predicting the prognosis of AEG especially for type II among patients underwent transhiatal approaches.
基金：
(1) National Natural
Science Foundation of China, No. 81372344, No. 81301866; (2)
Sichuan Province Youth Science and Technology Innovative Research
Team, No. 2015TD0009; (3) 1.3.5 project for disciplines of excellence,
West China Hospital, Sichuan University, No. ZY2017304; (4) Fund
Fig. 4 a The calibration curve for predicting all patients’ survival at
3 years (A) and 5 years (B) in both cohorts. b The calibration curve
for predicting Siewert type II patients,
survival at 3 years (A) and
5 years (B) in both cohorts (Nomogram-predicted probability of overall
survival is plotted on the x-axis; actual overall survival is plotted
on the y-axis) for Fostering Academic and Technical Leaders of Sichuan Province,
No. [2016] 183-19, No. [2017] 919.
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2019]版：
大类|2 区医学
小类|2 区肿瘤学2 区胃肠肝病学
最新[2023]版：
大类|1 区医学
小类|2 区胃肠肝病学2 区肿瘤学
第一作者：
第一作者机构：[1]Department of Gastrointestinal Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center for Biotherapy, No. 37 Guo Xue Xiang Street, Chengdu 610041, Sichuan, China
共同第一作者：
通讯作者：
推荐引用方式(GB/T 7714)：
Liu Kai,Feng Fan,Chen Xin-Zu,et al.Comparison between gastric and esophageal classification system among adenocarcinomas of esophagogastric junction according to AJCC 8th edition: a retrospective observational study from two high-volume institutions in China.[J].Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association.2019,22(3):506-517.doi:10.1007/s10120-018-0890-2.
APA：
Liu Kai,Feng Fan,Chen Xin-Zu,Zhou Xin-Yi,Zhang Jing-Yu...&Hu Jian-Kun.(2019).Comparison between gastric and esophageal classification system among adenocarcinomas of esophagogastric junction according to AJCC 8th edition: a retrospective observational study from two high-volume institutions in China..Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association,22,(3)
MLA：
Liu Kai,et al."Comparison between gastric and esophageal classification system among adenocarcinomas of esophagogastric junction according to AJCC 8th edition: a retrospective observational study from two high-volume institutions in China.".Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 22..3(2019):506-517
