Abstract
Objectives
To validate the prognostic value of the new American Joint Committee on Cancer (AJCC)
staging system (eighth edition) among different staging contexts (clinical vs. pathologic).
Methods
Surveillance, Epidemiology, and End Results (SEER) database (2010-2014) was accessed
through SEER*Stat program and both AJCC seventh and eighth edition stages were assigned
for each patient. Overall and cancer-specific survival analyses according to both
editions were conducted through Kaplan-Meier analysis. Concordance index (c-index)
was assessed for each edition.
Results
A total of 7074 patients with pathologically staged and 26,698 with clinically staged
urinary bladder carcinoma were identified in the period from 2010 to 2014. Among patients
with pathologically staged disease without neoadjuvant treatment, P values for all pairwise comparisons among different stages (according to AJCC seventh
and eighth systems) were significant for both overall and cancer-specific survivals
(< .01). Moreover, within the same cohort, c-index (using death from urinary bladder
cancer as the dependent variable) for AJCC seventh system was 0.714 (SE 0.008; 95%
CI, 0.699-0.729); whereas the c-index for the AJCC eighth system was 0.718 (SE 0.008;
95% CI, 0.702-0.733). Likewise, among patients with clinically staged disease, P values for all pairwise comparisons among different AJCC eighth stages were significant
for overall survival (< .05) except for stage IIIA versus stage IIIB; whereas P values for all pairwise comparisons among different AJCC eighth stages were significant
for cancer-specific survival (P < .05).
Conclusion
This analysis supports the prognostic relevance of the added substages described within
AJCC eighth edition stages III and IV for clinically staged and pathologically staged
disease without neoadjuvant treatment.
Keywords
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Article info
Publication history
Published online: August 02, 2017
Accepted:
July 27,
2017
Received in revised form:
July 22,
2017
Received:
May 23,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
