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Original Article Enhancing TNM Stage Completeness Using the SEER Summary Stage
Chang Kyun Choi1orcid , Mina Suh2,3orcid , Kyu-Won Jung4,5orcid , E Hwa Yun4,5corresp_iconorcid

DOI: https://doi.org/10.3961/jpmph.25.099 [Accepted]
Published online: April 23, 2025
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1Division of Cancer Early Detection, National Cancer Control Institute, National Cancer Center, Goyang, Korea
2National Cancer Control Institute, National Cancer Center, Goyang, Korea
3Graduate School of Cancer Science and Policy, National Cancer Center,, Goyang, Korea
4Korea Central Cancer Registry, National Cancer Center, Goyang, Korea
5Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
Corresponding author:  E Hwa Yun,
Email: ehwayun@ncc.re.kr
Received: 6 February 2025   • Revised: 20 March 2025   • Accepted: 27 March 2025

Objectives
Accurate and complete cancer staging is essential for effective prognosis and treatment planning. This study investigated the feasibility of enhancing the completeness of tumor‐node‐metastasis (TNM) staging by integrating Surveillance, Epidemiology, and End Results (SEER) Summary Stage data.
Methods
We analyzed data from 5 cancer types (stomach, colorectum, liver, lung, and breast) in South Korea (2012–2017). The study assessed the impact of supplementing missing TNM information with SEER Summary Stage data on both staging completeness and 5‐year relative survival rates.
Results
The study included 173,061 stomach cancer, 159,199 colorectal cancer, 89,639 liver cancer, 137,103 lung cancer, and 110,286 breast cancer patients. The percentage of missing TNM stage data varied by cancer type, ranging from 65.1% (breast cancer) to 93.0% (liver cancer). Supplementation significantly reduced missing values—most notably in stomach cancer, where missing data dropped by 50.6 percentage points, followed by liver (21.5 percentage points) and breast cancers (13.6 percentage points). For stomach cancer, supplementation led to a 3.6 percentage point decrease in stage I survival rates, whereas liver cancer exhibited the most pronounced changes, with stage IV survival rates declining from 17.7% to 7.9%.
Conclusions
Integrating SEER Summary Stage data enhances TNM staging completeness. However, further evaluation incorporating treatment information is essential.

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