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Ajani, Jaffer A.; In, Haejin; Sano, Takeshi; Gaspar, Laurie E.; Erasmus, Jeremy J.; Tang, Laura H.; Washington, Mary Kay; Gerdes, Hans; Wittekind, Christian; Mansfield, Paul F.; Rimmer, Cathy; Hofstetter, Wayne L.; Kelsen, David P.

doi:10.1007/978-3-319-40618-3_17

Cited by 52 publications

(41 citation statements)

References 9 publications

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“…Clinical stage was defined according to the institution protocol and included endoscopy with biopsy, abdominal, and pelvis computed tomography scan and diagnostic laparoscopy. Tumor stage was defined according to the 8th edition of the TNM . Preoperative CMT consisted of platin‐based (oxaliplatin or cisplatin) regimen.…”

Section: Methodsmentioning

confidence: 99%

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

Pereira

Ramos

Dias

et al. 2019

Journal of Surgical Oncology

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Background and Objective Neoadjuvant chemotherapy (nCMT) has been increasingly used in advanced gastric cancer (GC). However, the prognostic impact of tumor response remains unclear. This study aimed to evaluate if tumor response at the primary site and lymph nodes (LN) correlate with survival in GC patients after nCMT. Methods Patients with gastric adenocarcinoma treated with nCMT followed by gastrectomy were evaluated. Residual tumor was graded from 0% to 100%, defining two groups: poor (PR) and major response (MR). LN regression rate (LNRR) was determined based on tumor/fibrosis examination at each LN and a cutoff value established by receiver operating characteristic curve. Results Among 62 cases, 20 (32.2%) had MR and 42 (67.7%) PR. Smaller size, diffuse histology, lower ypT status and less advanced stage were associated with the MR group. Based on cutoff value of 57, 45.6% and 54.4% patients were classified as low‐LNRR and high‐LNRR. High‐LNRR correlated with absence of venous, lymphatic and perineural invasion, and less advanced stage. Survival was equivalent between MR and PR (P = .956). High‐LNRR had better disease‐free survival (DFS) than low‐LNRR (P < .001). In multivariate analysis, only LNRR associated with DFS. Conclusion High‐LNRR associates with DFS in GC treated with nCMT. Response at the primary site does not correlate with survival.

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Section: Methodsmentioning

confidence: 99%

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

Pereira

Ramos

Dias

et al. 2019

Journal of Surgical Oncology

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“…In an era in which multimodal therapy and patient-tailored therapy are crucial, optimal prognostic accuracy is mandatory to define the best treatment. These results could aim at influencing a future revision of the AJCC edition [47,48]. To the best of our knowledge, our study is the first from the Western world to compare nodal stage based on anatomical location of metastatic nodes rather than on the number of positive nodes.…”

Section: Resultsmentioning

confidence: 99%

Comparison of the current AJCC-TNM numeric-based with a new anatomical location-based lymph node staging system for gastric cancer: A western experience

et al. 2017

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BackgroundIn gastric cancer, the current AJCC numeric-based lymph node staging does not provide information on the anatomical extent of the disease and lymphadenectomy. A new anatomical location-based node staging, proposed by Choi, has shown better prognostic performance, thus soliciting Western world validation.Study designData from 284 gastric cancers undergoing radical surgery at the Second University of Naples from 2000 to 2014 were reviewed. The lymph nodes were reclassified into three groups (lesser and greater curvature, and extraperigastric nodes); presence of any metastatic lymph node in a given group was considered positive, prompting a new N and TNM stage classification. Receiver-operating-characteristic (ROC) curves for censored survival data and bootstrap methods were used to compare the capability of the two models to predict tumor recurrence.ResultsMore than one third of node positive patients were reclassified into different N and TNM stages by the new system. Compared to the current staging system, the new classification significantly correlated with tumor recurrence rates and displayed improved indices of prognostic performance, such as the Bayesian information criterion and the Harrell C-index. Higher values at survival ROC analysis demonstrated a significantly better stratification of patients by the new system, mostly in the early phase of the follow-up, with a worse prognosis in more advanced new N stages, despite the same current N stage.ConclusionsThis study suggests that the anatomical location-based classification of lymph node metastasis may be an important tool for gastric cancer prognosis and should be considered for future revision of the TNM staging system.

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“…For the 8th edition pTNM classification, definitions of T and N classifications were not changed, and only the final staging assignment of the pN3 classification was changed. The 7th edition pN3 classification was divided into pN3a and pN3b classifications in the 8th edition . Table shows detailed classifications based on the 7th and 8th editions of the AJCC TNM classification.…”

Section: Methodsmentioning

confidence: 99%

“…The AJCC TNM system is recognized as the best malignant tumor staging system worldwide. Over recent decades, the AJCC TNM staging system has been revised continuously, and the most recent 8th edition of the TNM classification published in 2016 replaced the 7th edition from 2009 . Changes to the latest classifications of gastric cancer were mainly based on data analyses from the US and Japan.…”

Section: Introductionmentioning

confidence: 99%

Validation of the American Joint Commission on Cancer (8th edition) changes for patients with stage III gastric cancer: survival analysis of a large series from a Specialized Eastern Center

et al. 2017

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The 8th edition of the TNM was released in 2016 and included major revisions, especially for stage III. We aimed to compare the prognostic value of the 7th and 8th editions of the AJCC TNM classification for stage III gastric cancer. Clinical data from 1557 patients operated on for stage III gastric cancer according to the 7th edition between 2007 and 2014 were analyzed and compared using the 7th and 8th TNM classifications. A proposed staging system was established, and the three systems were compared in terms of prognostic performance. The stage shifted for 669 (42.96%) patients. It shifted from IIIA to IIIB (one patient, 0.06%), IIIB to IIIA (230 patients, 14.8%), IIIB to IIIC (94 patients, 6.0%), and IIIC to IIIB (344 patients, 22.1%). However, the new AJCC subgroupings did not prove distinctive for survival levels between T3N3aM0 (stage IIIB) and T3N3bM0 (stage IIIC) or between T4aN3aM0 (stage IIIB) and T4aN3bM0 (stage IIIC) when <30 lymph nodes (LNs) were resected. The performance of the 8th edition (c‐index, 0.614; 95% confidence interval [CI], 0.596–0.633) revealed no relevant improvement compared to the 7th edition (c‐index, 0.624; 95% CI, 0.605–0.643). The proposed staging system generated the best prognostic stratification. The 8th TNM edition may not provide better accuracy in predicting the prognosis of stage III gastric cancer. The proposed staging system, comprised of a combination of the number of LNs harvested and the 7th and 8th AJCC classifications, may improve predictive capacities for stage III gastric cancer.

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Untitled

Cited by 52 publications

References 9 publications

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

Lymph node regression after neoadjuvant chemotherapy: A predictor of survival in gastric cancer

Comparison of the current AJCC-TNM numeric-based with a new anatomical location-based lymph node staging system for gastric cancer: A western experience

Validation of the American Joint Commission on Cancer (8th edition) changes for patients with stage III gastric cancer: survival analysis of a large series from a Specialized Eastern Center

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