• Jianxian Lin, YaJun Zhao, Yanbing Zhou, Hankun Hao, Qingliang He, Yantao Tian, Bingbing Zou, Gang Zhao, Xiantu Qiu, Linxin Jiang, Zhi Li, Yanchang Xu, Fangqin Xue, Weihua Fu, Zekuan Xu, Yongxiang Li, Shuliang Li, Jinping Chen, Xiaojun Zhou, Zhenggang Zhu, Honglang Li, Yong Li, En Li, Lisheng Cai, Guiqing Jia, Jian-Wei Xie, Ping Li, Chao-Hui Zheng, and Chang-Ming Huang.
• Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
• Neuroendocrinology. 2021 Jan 1; 111 (11): 1130-1140.

PurposeTo evaluate whether the European Neuroendocrine Tumor Society (ENETS) system or the 8th American Joint Committee on Cancer (AJCC) staging manual are suitable for gastric neuroendocrine carcinomas and/or mixed adenoneuroendocrine carcinomas (G-NECs/MANECs).MethodsPatients in a multicentric series with G-NEC/MANEC who underwent curative-intent surgical resection for a primary tumor were included. An optimal staging system was proposed base on analysis of the T and N status and validated by the SEER database.ResultsCompared with the ENETS system, the survival curves of the T category and N category in the 8th AJCC system were better separated and distributed in a more balanced way, but the survival curves of T2 vs. T3, N0 vs. N1, and N3a vs. N3b overlapped. For the T category, the 8th AJCC T category was modified by combining T2 and T3, which was consistent with the T category in the 6th AJCC manual for GC. For the N category, the optimal cut-off values of metastatic lymph nodes using X-tile were also similar to those of the N category in the 6th AJCC system. The Kaplan-Meier plots of the 6th AJCC system showed statistically significant differences between individual substages. Compared with the other 2 classifications, the 6th AJCC system also showed superior prognostic stratification. Similar results were obtained in both multicentric and SEER validation sets.ConclusionsCompared to the 8th AJCC and ENETS systems, the 6th AJCC staging system for GC is more suitable for G-NEC/MANEC and can be adopted in clinical practice.© 2020 S. Karger AG, Basel.

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