title: Validation of the updated 7th edition AJCC TNM staging criteria for gastric adenocarcinoma.
abstract: BACKGROUND
  The recently published 7th edition of the American Joint Committee on Cancer (AJCC) TNM staging criteria for gastric adenocarcinoma contains important revisions to T and N classifications, as well as overall stage grouping. Our goal was to validate the new staging system using a cancer registry.
  
  
  METHODS
  Retrospective review of gastric cancer patients from Surveillance, Epidemiology, and End Results (SEER) registry data (2004-2007). Patients were staged according to both 6th and 7th edition criteria, and 3-year disease-specific survival was compared.
  
  
  RESULTS
  Thirteen thousand five hundred forty-seven patients with gastric adenocarcinoma were identified with complete staging information. When using 7th edition criteria, there was an increase in the number of patients classified as stage III (23% vs. 13%), and a decrease in patients classified as stage IV (47% vs. 53%). Statistically significant differences in 3-year disease-specific survival were observed for all T and N categories and re-staging the same population according to the 7th edition criteria improved survival discrimination. Multivariate analysis revealed statistically significant differences in survival and linear progression of hazard ratios for each stage grouping.
  
  
  CONCLUSIONS
  The 7th edition AJCC staging criteria for gastric adenocarcinoma demonstrate better survival discrimination and risk stratification than previous criteria.
authors.affiliation: Department of Surgery, Section of Surgical Oncology, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA.
authors.forename: Lee J
authors.initials: LJ
authors.lastname: McGhan
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Pockaj
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Gray
authors.forename: Sanjay P
authors.initials: SP
authors.lastname: Bagaria
authors.forename: Nabil
authors.initials: N
authors.lastname: Wasif
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology*; D000368:Aged; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging / Q000592:standards*; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology*; D014481:United States