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

 Yoon Young Choi  ;  Eunji Jang  ;  Won Jun Seo  ;  Taeil Son  ;  Hyoung-Il Kim  ;  Hyeseon Kim  ;  Woo Jin Hyung  ;  Yong-Min Huh  ;  Sung Hoon Noh  ;  Jae-Ho Cheong 
 Journal of Gastric Cancer, Vol.18(2) : 142-151, 2018 
Journal Title
 Journal of Gastric Cancer 
Issue Date
Classification ; biomarker ; gastric cancer ; prognosis ; staging
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.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
김형일(Kim, Hyoung Il) ORCID logo https://orcid.org/0000-0002-6134-4523
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
서원준(Seo, Won Jun)
손태일(Son, Tae Il) ORCID logo https://orcid.org/0000-0002-0327-5224
정재호(Cheong, Jae Ho) ORCID logo https://orcid.org/0000-0002-1703-1781
최윤영(Choi, Yoon Young) ORCID logo https://orcid.org/0000-0002-2179-7851
허용민(Huh, Yong Min) ORCID logo https://orcid.org/0000-0002-9831-4475
형우진(Hyung, Woo Jin) ORCID logo https://orcid.org/0000-0002-8593-9214
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