A novel TNM staging system for gastric cancer based on the metro-ticket paradigm: a comparative study with the AJCC-TNM staging system

BackgroundThe metro-ticket prognostic tool for hepatocellular carcinoma has been proven to predict outcome, but a similar concept has not been investigated for GC. The objective of the current study was to apply the principles of the metro-ticket paradigm to develop a novel TNM staging system (nTNM) for gastric cancer (GC).MethodsThe nTNM considered the distance from the origin on a Cartesian plane incorporating the pN (x-axis) and pT (y-axis) stages. GC patients undergoing radical resection at Fujian Medical University Union Hospital (FMUUH) (n=4267) were included. The nTNM was validated using 2 external cohorts from the Sun Yat-sen University Cancer Center (SYSUCC) (n=1800) and Surveillance, Epidemiology, and End Results (SEER) (n=3227) databases.ResultsnTNM classes with the same distance from the origin have same stage; the stage increases with this distance. Among all patients, 48.0% (n=2049) were restaged in the nTNM compared with the 7th edition of the AJCC-TNM classification; 26.2% (n=1116) were downstaged in the nTNM compared with the 8th edition. The nTNM provides significant survival differences between stages (all P<0.001). The survival difference between stages IB and IIA was especially large for the nTNM (P<0.001) compared to the 7th and 8th editions (P=0.073). The concordance index and hazard ratio increased successively with the nTNM stage. Similar findings were observed in both external cohorts.ConclusionCompared with the AJCC-TNM classification, the nTNM for GC is easier to remember and provides some improvements; therefore, the nTNM may be considered for adoption in future editions of the AJCC-TNM classification.