title: Seventh edition (2010) of the AJCC/UICC staging system for gastric adenocarcinoma: is there room for improvement?
abstract: BACKGROUND
  The gastric cancer AJCC/UICC staging system recently underwent significant revisions, but studies on Asian patients have reported a lack of adequate discrimination between various consecutive stages. We sought to validate the new system on a U.S. population database.
  
  
  METHODS
  California Cancer Registry data linked to the Office of Statewide Health Planning and Development discharge abstracts were used to identify patients with gastric adenocarcinoma (esophagogastric junction and gastric cardia tumors excluded) who underwent curative-intent surgical resection in California from 2002 to 2006. AJCC/UICC stage was recalculated based on the latest seventh edition. Overall survival probabilities were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  Of 1905 patients analyzed, 54 % were males with a median age of 70 years. Median number of pathologically examined lymph nodes was 12 (range, 1-90); 40 % of patients received adjuvant chemotherapy, and 31 % received adjuvant radiotherapy. The seventh edition AJCC/UICC system did not distinguish outcome adequately between stages IB and IIA (P = 0.40), or IIB and IIIA (P = 0.34). By merging stage II into 1 category and moving T2N1 to stage IB and T2N2, T1N3 to stage IIIA, we propose a new grouping system with improved discriminatory ability
  
  
  CONCLUSIONS
  In this first study validating the new seventh edition AJCC/UICC staging system for gastric cancer on a U.S. population with a relatively limited number of lymph nodes examined, we found stages IB and IIA, as well as IIB and IIIA to perform similarly. We propose a revised stage grouping for the AJCC/UICC staging system that better discriminates between outcomes.
authors.affiliation: Department of Medicine, Division of Oncology, Stanford University Medical Center, Stanford, CA, USA.
authors.forename: Manali I
authors.initials: MI
authors.lastname: Patel
authors.forename: Kim F
authors.initials: KF
authors.lastname: Rhoads
authors.forename: Yifei
authors.initials: Y
authors.lastname: Ma
authors.forename: James M
authors.initials: JM
authors.lastname: Ford
authors.forename: Brendan C
authors.initials: BC
authors.lastname: Visser
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Kunz
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Chang
authors.forename: Albert
authors.initials: A
authors.lastname: Koong
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Norton
authors.forename: George A
authors.initials: GA
authors.lastname: Poultsides
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D017024:Chemotherapy, Adjuvant; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult