Background or Purpose
This study was designed to determine the value of AJCC staging 7th edition and improved AJCC staging in assessing the prognosis of gastric neuroendocrine carcinoma (GNEC).
In total, GNEC 475 patients in the Surveillance, Epidemiology, and End Results (SEER) database and 129 GNEC patients in our department undergoing resection were included. The former served as the test group, and the latter served as the validation group. Those with stage IIIb disease were allocated into four subgroups, and improved AJCC staging was established. The AIC and C indices were used to evaluate the capacities of different TNM staging.
Significant overlap between stages IIIb and IIIa in both the test and validation groups was found. In the test group, T staging and age at disease diagnosis were independent prognostic factors for patients with stage IIIb. Stage IIIb was divided into T1N1, T2N1, T3N1 and T4N1, and the improved AJCC staging–mTNM staging was created. In mTNM staging, the IIIb survival curve did not cross those of stages IIIa and IIb, which had a smaller AIC (2490 vs. 2507) value and larger C index (0.7624 vs. 0.7450, P = 0.228). Similar results were obtained for the validation group.
T stage was an independent factor influencing the prognosis of stage IIIb GNEC patients, and the improved AJCC staging proposed here has good prognostic value.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Bosman FT, Carneiro F, Hruban RH et al (2010) WHO classification of tumours of the digestive system. World Health Organization, Geneva
Cho MY, Kim JM, Sohn JH et al (2012) Current trends of the incidence and pathological diagnosis of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) in Korea 2000–2009: multicenter study. Cancer Res Treat Off J Korean Cancer Assoc 44(3):157–165
Donohoe CL, O’Farrell NJ, Grant T et al (2013) Classification of pathologic response to neoadjuvant therapy in esophageal and junctional cancer: assessment of existing measures and proposal of a novel 3-point standard. Ann Surg 258(5):784–792; discussion 792
Garcia-Carbonero R, Sorbye H, Baudin E et al (2016) ENETS consensus guidelines for high-grade gastroenteropancreatic neuroendocrine tumors and neuroendocrine carcinomas. Neuroendocrinology 103(2):186–194
Kidd M, Modlin I, Oberg K (2016) Towards a new classification of gastroenteropancreatic neuroendocrine neoplasms. Nature Rev Clin Oncol 13(11):691–705
Kim MK, Warner RR, Roayaie S et al (2013) Revised staging classification improves outcome prediction for small intestinal neuroendocrine tumors. J Clin Oncol 31(30):3776–3781
Kim BS, Park YS, Yook JH et al (2015) Differing clinical courses and prognoses in patients with gastric neuroendocrine tumors based on the 2010-WHO classification scheme. Medicine 94(44):e1748
Lawrence B, Kidd M, Svejda B et al (2011a) A clinical perspective on gastric neuroendocrine neoplasia. Curr Gastroenterol Rep 13(1):101–109
Lawrence B, Gustafsson BI, Chan A et al (2011b) The epidemiology of gastroenteropancreatic neuroendocrine tumors. Endocrinol Metab Clin N Am 40(1):1–18, vii
Li B, Li Y, Wang W et al (2016) Incorporation of N0 stage with insufficient numbers of lymph nodes into N1 stage in the seventh edition of the TNM classification improves prediction of prognosis in gastric cancer: results of a single-institution study of 1258 chinese patients. Annal Surg Oncol 23(1):142–148
Lu J, Wang W, Zheng CH et al (2017) Influence of total lymph node count on staging and survival after gastrectomy for gastric cancer: an analysis from a two-institution database in China. Ann Surg Oncol 24(2):486–493
Luo G, Javed A, Strosberg JR et al (2017) Modified staging classification for pancreatic neuroendocrine tumors on the basis of the American Joint Committee on Cancer and European Neuroendocrine Tumor Society Systems. J Clin Oncol 35(3):274–280
Martin JA, Warner RR, Wisnivesky JP, et al (2017 May) Improving survival prognostication of gastroenteropancreatic neuroendocrine neoplasms: revised staging criteria. Eur J Cancer 76:197–204. https://doi.org/10.1016/j.ejca.2017.02.008. (Epub 2017 Mar 20)
Niederle MB, Hackl M, Kaserer K et al (2010) Gastroenteropancreatic neuroendocrine tumours: the current incidence and staging based on the WHO and European Neuroendocrine Tumour Society classification: an analysis based on prospectively collected parameters. Endocr Relat Cancer 17(4):909–918
Parnaby CN, Scott NW, Ramsay G et al (2015) Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection. Br J Cancer 113(2):212–219
Plockinger U, Rindi G, Arnold R et al (2004) Guidelines for the diagnosis and treatment of neuroendocrine gastrointestinal tumours. A consensus statement on behalf of the European Neuroendocrine Tumour Society (ENETS). Neuroendocrinology 80(6):394–424
Sano T, Coit DG, Kim HH et al (2017) Proposal of a new stage grouping of gastric cancer for TNM classification: International Gastric Cancer Association staging project. Gastric Cancer 20(2):217–225
Shen C, Chen H, Chen H et al (2016) Surgical treatment and prognosis of gastric neuroendocrine neoplasms: a single-center experience. BMC Gastroenterol 16:111
Tang X, Chen Y, Guo L et al (2015) Prognostic significance of metastatic lymph node number, ratio and station in gastric neuroendocrine carcinoma. J Gastrointest Surg 19(2):234–241
Ueno H, Mochizuki H, Akagi Y et al (2012) Optimal colorectal cancer staging criteria in TNM classification. J Clin Oncol 30(13):1519–1526
Wang HH, Li K, Xu H et al (2017) Improvement of T stage precision by integration of surgical and pathological staging in radically resected stage pT3-pT4b gastric cancer. Oncotarget 8: 46506
Xie JW, Sun YQ, Feng CY et al (2016) Evaluation of clinicopathological factors related to the prognosis of gastric neuroendocrine carcinoma. Eur J Surg Oncol 42(10):1464–1470
Zhang J, Niu Z, Zhou Y et al (2013) A comparison between the seventh and sixth editions of the American Joint Committee on Cancer/International Union against classification of gastric cancer. Ann Surg 257(1):81–86
This work was supported by the scientific and technological innovation joint capital projects of Fujian Province (2016Y9031), Construction Project of Fujian Province Minimally Invasive Medical Center (No. 171), the MiaoPu Fund for Scientific Research, Fujian Medical University (No. 2014MP022) and the second batch of special support funds for Fujian Province innovation and entrepreneurship talents (2016B013).
Conflict of interest
All of the authors declare that they have no potential commercial conflicts of interest relevant to this article.
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Xie, J., Li, P., Wang, J. et al. Modified AJCC staging of gastric neuroendocrine carcinoma based on T staging can improve the capacity of prognosis assessment. J Cancer Res Clin Oncol 144, 2391–2397 (2018). https://doi.org/10.1007/s00432-018-2750-1
- Neuroendocrine carcinoma