Clinical Utility of ypTNM Stage Grouping in the 8th Edition of the American Joint Committee on Cancer TNM Staging System
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ORIGINAL ARTICLE – THORACIC ONCOLOGY
Clinical Utility of ypTNM Stage Grouping in the 8th Edition of the American Joint Committee on Cancer TNM Staging System for Esophageal Squamous Cell Carcinoma Natsuru Sudo, MD, PhD1, Hiroshi Ichikawa, MD, PhD1, Yusuke Muneoka, MD, PhD1, Takaaki Hanyu, MD, PhD1, Yosuke Kano, MD, PhD1, Takashi Ishikawa, MD, PhD1, Yuki Hirose, MD, PhD1, Kohei Miura, MD, PhD1, Yoshifumi Shimada, MD, PhD1, Masayuki Nagahashi, MD, PhD1, Jun Sakata, MD, PhD1, Takashi Kobayashi, MD, PhD1, Takeo Bamba, MD, PhD2, Satoru Nakagawa, MD, PhD2, Shin-ichi Kosugi, MD, PhD3, and Toshifumi Wakai, MD, PhD, FACS1 1
Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 2Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan; 3Department of Digestive and General Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
ABSTRACT Background. The 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system provided a specific ‘ypTNM’ stage grouping for patients with esophageal cancer. Objective. This study aimed to evaluate the clinical utility of the AJCC 8th edition ypTNM stage grouping for patients with esophageal squamous cell carcinoma (ESCC). Methods. We enrolled 152 patients with ESCC who underwent surgery after neoadjuvant cisplatin plus 5-fluorouracil (CF) therapy between June 2005 and December 2011. ypStage was evaluated according to the AJCC 7th and 8th editions. Predictive performance for diseasespecific survival (DSS) and overall survival (OS) was compared between both editions. The prognostic significance of ypTNM stage grouping was evaluated using univariate and multivariate analyses.
Electronic supplementary material The online version of this article (https://doi.org/10.1245/s10434-020-09181-3) contains supplementary material, which is available to authorized users. Ó Society of Surgical Oncology 2020 First Received: 4 March 2020 Accepted: 9 August 2020 H. Ichikawa, MD, PhD e-mail: [email protected]
Results. Revision of the AJCC 7th edition to the 8th edition was associated with a change in ypStage in 96 patients (63.2%). The AJCC 8th edition revealed a better predictive performance than the 7th edition in terms of DSS (Akaike’s information criterion [AIC] 499 vs. 513; Bayesian information criterion [BIC] 505 versus 519; concordance index [C-index] 0.725 versus 0.679) and OS (AIC 662 vs. 674; BIC 669 vs. 681; C-index 0.662 vs. 0.622). On univariate and multivariate analyses, ypStage in the 8th edition was an independent prognostic factor for both DSS and OS. Conclusions. ypTNM stage grouping in the AJCC 8th edition provided a better predictive performance for DSS and OS than that in the 7th edition. ypStage in the 8th edition was the most reliable prognostic factor for ESCC patients who underwent surgery after neoadjuvant CF therapy.
Radical surgery is one of the primary curative treatments for esophageal
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