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, WooJin Hyung, yongmin Huh, Sung Hoon Noh, Jae Ho Cheong

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish
Pages (from-to)142-151
Number of pages10
JournalJournal of Gastric Cancer
Volume18
Issue number2
DOIs
Publication statusPublished - 2018 Jun 1

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Stomach Neoplasms
Neoplasm Metastasis
Neoplasms
Confidence Intervals
Survival
Neoplasm Staging
Gastrectomy
Anatomy
Messenger RNA

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Cite this

Choi, Yoon Young ; Jang, Eunji ; Seo, Won Jun ; Son, Taeil ; Kim, Hyoung Il ; Kim, Hyeseon ; Hyung, WooJin ; Huh, yongmin ; Noh, Sung Hoon ; Cheong, Jae Ho. / Modification of the TNM staging system for stage II/III gastric cancer based on a prognostic single patient classifier algorithm. In: Journal of Gastric Cancer. 2018 ; Vol. 18, No. 2. pp. 142-151.
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title = "Modification of the TNM staging system for stage II/III gastric cancer based on a prognostic single patient classifier algorithm",
abstract = "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.",
author = "Choi, {Yoon Young} and Eunji Jang and Seo, {Won Jun} and Taeil Son and Kim, {Hyoung Il} and Hyeseon Kim and WooJin Hyung and yongmin Huh and Noh, {Sung Hoon} and Cheong, {Jae Ho}",
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Modification of the TNM staging system for stage II/III gastric cancer based on a prognostic single patient classifier algorithm. / Choi, Yoon Young; Jang, Eunji; Seo, Won Jun; Son, Taeil; Kim, Hyoung Il; Kim, Hyeseon; Hyung, WooJin; Huh, yongmin; Noh, Sung Hoon; Cheong, Jae Ho.

In: Journal of Gastric Cancer, Vol. 18, No. 2, 01.06.2018, p. 142-151.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Modification of the TNM staging system for stage II/III gastric cancer based on a prognostic single patient classifier algorithm

AU - Choi, Yoon Young

AU - Jang, Eunji

AU - Seo, Won Jun

AU - Son, Taeil

AU - Kim, Hyoung Il

AU - Kim, Hyeseon

AU - Hyung, WooJin

AU - Huh, yongmin

AU - Noh, Sung Hoon

AU - Cheong, Jae Ho

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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.

AB - 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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DO - 10.5230/jgc.2018.18.e14

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JO - Journal of Gastric Cancer

JF - Journal of Gastric Cancer

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