| OBJECTIVE:This study anslysis the differences between the6th TNM staging system and7th TNM staging system of gastric cancer.METHODS:520patients of gastric cancer were selected in Tianjin Cancer Hospital form January2001to December31,2008.1. All patients were assessed by6th and7th TNM staging system, the5-year survival and overall survival was calculated and compared between two editions.2.the possible factors which was influenced the overall survival was calculated by COX proportional hazard model analysis.3. the-2Log likelihood, Akaike information criterion and Bayesian information criterion of the6th and7th TNM staging system was calculated.4. The data comparison was used by Chi-square test, survival was determined by the Kaplan-Meier method and Log-rank test univariate analysis. Multivariate analysis was performed using the Cox proportional hazard regression model. value<0.05was considered to be statistically significant. The statistical analysis was performed using the statistical analysis program package SPSS18.0.RESULTS:1.520patients of gastric cancer were included in the study,344cases were male (66.2%), female were176cases (33.8%), the rate of stage migration was52.3%.2.5-year survival rates of6th edition T stage were94.1%,74.1%,60.0%,40.4%,16.4%(P<0.001),5-year survival rates of7th edition T stage were100%,90.9%,74.1%,60.0%,40.4%,16.4%, the differences was significant (P<0.001). Compared with version6T staging, stage migration could be found in the T staging of7th edition.3.5-year survival rates of6th edition N stage were75.6%,43.9%,13.6%,7.5%,(P<0.001),5-year survival rates of7th edition N stage were75.6%,54.7%,35.0%,13.6%,7.5%, the differenct was significant (P=0.000). There were significantly different between N1stage in7th edition and N2stage (P<0.005).4. The7th TNM staging show more details than the6th TNM staging. The sub-stage of the6th TNM staging from6rose to8stages in The7th TNM.5-year overall survival in6th edition TNM stage I-IV were100%,81.5%,64.5%,44.7%,13.6%,11.1%(P=0.001).5-year overall survival in7th edition TNM stage I-IV were100%,83.7%,62.5%,66.7%,55.8%,36.7%,12.4%,2.6%, the differenert were statistically significant (P<0.001).5. Univariate analysis showed:age, histological type, tumor location, tumor size, gross type, extent of surgery, T stage of6th and7th edition version,N stage of6th and7th, M stage, TNM staging of version6th and7th was was related with overall survival(P<0.05). The6th of T stage, N stage, M stage, TNM stage and clinicopathological factors included COX proportional hazards model for multivariate analysis showed:6th T staging (P=0.042), N staging (P=0.001), TNM staging (P <0.001) were independent prognostic factor in gastric cancer patients (P<0.05). The7th of T stage, N stage, M stage, TNM stage and clinicopathological factors included COX proportional hazards model for multivariate analysis showed:7th T staging (P <0.001), N staging (P<0.001), TNM staging (P<0.001) were independent prognostic factor in gastric cancer patients (P<0.05). T stage, N stage, TNM stage of6th and of T stage, N stage, TNM stage were highly correlated, so we put them into the same COX proportional hazards model for multivariate analysis showed:Version7T staging (P<0.001), N staging (P<0.001), TNM staging (P=0.026) was the independent prognostic factor in gastric cancer patients6.-2Log-likelihood of T staging of6th edition was3463.447. The T staging of7th was3462.703.-2Log-likelihood of N staging of6th edition was3369.167, The N staging of7th was3354.001.-2Log-likelihood of TNM staging of6th edition was3365.134, The TNM staging of7th was3339.171. The AIC, BIC values of TNM of6th edition were595.963,670.285. The AIC, BIC values of TNM of7th edition549.001,663.677the-2Log-likelihood, AIC, BIC values of7th staging were less than version6th indicating that the7th version staging prognostic system was better than the version of6th staging prognostic system.CONCLUSION:1. T staging of7th edition staging changed little but more important for the clinical significance. Take3lymph nodes as the cutoff point of7th N staging, and7th staging were superior to the6th N stage2. From a variety of statistical verification, the7th TNM staging was superior to the 6th staging,7th TNM staging showed better performance in assessing the prognosis of gastric cancer patients. |
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