Application and validation of a tumor-deposit-based modified pN staging(mpN)system for prognostic prediction in gastric cancer
10.7659/j.issn.1005-6947.250562
- VernacularTitle:基于肿瘤沉积数目的改良pN分期(mpN)在胃癌预后预测中的应用与验证
- Author:
Bowen HUANG
1
;
Junzhi ZHOU
;
Zhihao CHEN
;
Yingjia CHEN
;
Ruopeng ZHANG
;
Wenkai WANG
;
Junjiang WANG
;
Baiwei ZHAO
Author Information
1. 中山大学肿瘤防治中心 胃外科/华南肿瘤学国家重点实验室/广东省恶性肿瘤临床研究中心,广东 广州 510060;中山大学 中山医学院,广东 广州 510080
- Publication Type:Journal Article
- Keywords:
Stomach Neoplasms;
Extranodal Extension;
Prognosis;
Neoplasm Staging;
Inverse Probability of Treatment Weighting
- From:
Chinese Journal of General Surgery
2025;34(10):2095-2105
- CountryChina
- Language:Chinese
-
Abstract:
Background and Aims:Tumor deposits(TDs)may influence prognosis beyond the current 8th edition AJCC pTNM nodal classification in gastric cancer(GC).This study investigates the prognostic value of TD number and proposes an improved pN staging(mpN)that classifies patients with TD number>1 as pN3b.We validated the mpN staging against the 8th AJCC pN staging.Methods:A dual-center retrospective cohort study was performed,including 1 327 patients who underwent radical gastrectomy at Sun Yat-sen University Cancer Center(2011-2015;test cohort)and 340 patients from Guangdong Provincial People's Hospital(2015-2022;validation cohort).Patients were dichotomized into low-TD(≤1)and high-TD(>1)groups.Outcomes were overall survival(OS)and disease-free survival(DFS).Survival analyses used Kaplan-Meier curves,IPTW,and Cox regression.Predictive performance of staging systems was assessed by time-dependent ROC(tROC)/tAUC,concordance index(C-index)and Akaike information criterion(AIC).Results:TDs were present in 435/1 327(32.7%)in the test cohort.Presence of TD was associated with worse OS(IPTW-adjusted HR=2.69,95%CI=2.18-3.31,P<0.01)and DFS(HR=2.82,95%CI=2.32-3.42,P<0.01).In multivariable models,TD remained an independent adverse factor for OS(HR=1.65,95%CI=1.34-2.05;P<0.01)and DFS(HR=1.74,95%CI=1.43-2.11,P<0.01).Increasing TD number correlated with progressively poorer survival;X-tile identified>1 as an optimal cutoff,with high-TD patients showing markedly worse outcomes(OS:adjusted HR=3.65,95%CI=2.74-4.88;DFS:adjusted HR=3.74,95%CI=2.85-4.91;both P<0.01).Incorporation of TD number into the mpN staging(assigning TD>1 to pN3b)improved prognostic discrimination:in the test cohort 5-year OS tAUC was 0.746 for mpN vs.0.703 for AJCC pN(C-index 0.738 vs.0.721,AIC 5 805.27 vs.5 849.30);similar improvements were observed in the validation cohort.Conclusion:TD presence and number exert significant negative prognostic impact in GC.Classifying patients with TD number>1 as pN3b enhances prognostic accuracy.Routine reporting of TD counts and further prospective multicenter validation of mpN staging are warranted.
