Abstract:
Objective To investigate whether the ypTNM staging combined with AJCC-TRG could further divide and expand the current staging system for the prognostic evaluation of patients with local advanced gastric cancer (LAGG) in different subgroups.
Methods Clinical data of patients with locally advanced gastric cancer who received neoadjuvant chemotherapy at The Affiliated Cancer Hospital of Zhengzhou University from January 2012 to February 2016 were retrospectively analyzed. Postoperative tissue samples from each patient were re-evaluated according to AJCC 8th edition ypTNM staging and AJCC-TRG standard. The system was then divided into nine different subgroups according to the ypTNM staging combined with TRG grading after neoadjuvant chemotherapy. Next, the 3-, 5-year overall survival (OS) rates and median OS (mOS) were calculated using the Kaplan-Meier survival curve, and the original ypTNM staging system was further divided and expanded based on the results.
Results This study included 424 patients with locally advanced gastric cancer, among whom 330 and 94 were males and females, respectively, and the median age of the patients was 60 years. The mOS was 40 months. In the same ypTNM stage combined with different TRG subgroups, the results of the Kaplan-Meier survival curve were as follows: 1) in the ypTNM stageⅠ, there was no significant difference in OS between TRG1 and TRG2 (P=0.715), but there were significant differences in OS between TRG1 and TRG3 (P=0.001), and between TRG2 and TRG3 (P=0.001), with the worst prognosis was in TRG3 patients (mOS was 23 months); 2) in the ypTNM stageⅡ: there was no significant difference in OS between TRG1 and TRG2 (P=0.105), but there were significant differences in OS between TRG1 and TRG3 (P<0.001), and between TRG2 and TRG3 (P=0.006), with the worst prognosis was in TRG3 patients (mOS of the three subgroups were 79, 52, and 35 months, respectively); 3) in the ypTNM stageⅢ: there were significant differences in OS between TRG1 and TRG2 (P=0.001), between TRG1 and TRG3 (P<0.001) and between TRG2 and TRG3 (P<0.001), with the worst prognosis was in TRG3 patients (mOS of the three subgroups were 51, 23, and 15 months, respectively).
Conclusions The combination of ypTNM staging and AJCC-TRG grade can further divide and expand the original staging system, select the patients with the worst prognosis at each stage, and help clinicians to judge a patient's condition and provide individualized treatment.
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