Classification of regional lymph node metastasis from gastric carcinoma

Roder, J. D.; Böttcher, K.; Busch, Raymonde; Wittekind, Christian; Hermanek, P.; Siewert, J. R.

doi:10.1002/(sici)1097-0142(19980215)82:4<621::aid-cncr2>3.0.co;2-o

Cited by 106 publications

(10 citation statements)

References 22 publications

(3 reference statements)

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“…Thus, in 1997 the UICC definitively introduced the 5th TNM edition, which includes the numeric count of metastatic nodes, whereas previously only their topographic location was considered. Some reports have compared the 5th TNM edition's system with previous anatomy-based classification schemes [6,[17][18][19][20]; three papers have specifically compared the 5th TNM edition with the Japanese classification system [21][22][23]. In the study by Hayashi et al [21], data from 940 patients who underwent surgery for gastric cancer were reviewed: all cases in this series had been previously classified according to the JRSGC criteria and subsequently re-evaluated on the basis of the latest TNM numeric classification.…”

Section: Discussionmentioning

confidence: 99%

Impact of the latest TNM classification for gastric cancer: Retrospective analysis on 94 D2 gastrectomies

et al. 2002

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The aim of this study was to determine whether the latest edition of tumor-node-metastasis (TNM) classification provides reliable prognostic information. The fifth edition of TNM Classification of Malignant Tumors has introduced for gastric cancer the numeric count of involved lymph nodes whereas their topographic location was considered in earlier editions. For our study, data from 94 patients who underwent D2-gastrectomy were reviewed. The N-factor was scored according to both the Japanese Research Society for Gastric Cancer (JRSGC) classification (n) and, retrospectively, the latest TNM classification (N). Actuarial survival was calculated for both groups. The two staging systems showed similar stratification of actuarial survival with relation to N-stage; in the JRSGC classification no statistical differences were observed between n1 and n2 patients (62.7% vs. 52.5%; p = NS), whereas the 5th TNM classification showed a significant difference between N1 and N2 patients (68.5% vs. 45.0%; p = 0.04), and between N1 and the new category of N3 patients (68.5% vs. 45.0%, p = 0.03). It appears, therefore, that the numeric count of involved nodes may represent a more reliable indicator for single-case prognosis. Reclassification of all node-positive patients in our series caused an overall stage modification in 32.9% (31/94); 22 of those patients were reclassified to a less favorable stage (23.4%). In addition, 11.7% of patients (6/51) who were previously designated n1 were reclassified as N2, shifting from an expected actuarial survival after 72 months of 62.7% to 33.3%.

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Section: Discussionmentioning

confidence: 99%

Impact of the latest TNM classification for gastric cancer: Retrospective analysis on 94 D2 gastrectomies

et al. 2002

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“…In advanced carcinoma, lymph node status is an important prognostic factor not only regarding long-term survival, but also planning the optimal extent of lymphadenectomy [16]. In terms of simplicity, reproducibility, homogeneity, and prognostic relevance after gastrectomy, the sixth edition of the International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) staging system, which is the current standard for determining pathologic stage, bases pathologic nodal status on the number of lymph nodes involved [15], [17]–[22]. It differs from criteria used by earlier investigators, who followed Japanese guidelines defined in the General Rules for Gastric Cancer Study in Surgery and Pathology [19]–[20].…”

Section: Introductionmentioning

confidence: 99%

Gastric Cancer Staging with Dual Energy Spectral CT Imaging

et al. 2013

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PurposeTo evaluate the clinical utility of dual energy spectral CT (DEsCT) in staging and characterizing gastric cancers.Materials and Methods96 patients suspected of gastric cancers underwent dual-phasic scans (arterial phase (AP) and portal venous phase (PP)) with DEsCT mode. Three types of images were reconstructed for analysis: conventional polychromatic images, material-decomposition images, and monochromatic image sets with photon energies from 40 to 140 keV. The polychromatic and monochromatic images were compared in TNM staging. The iodine concentrations in the lesions and lymph nodes were measured on the iodine-based material-decomposition images. These values were further normalized against that in aorta and the normalized iodine concentration (nIC) values were statistically compared. Results were correlated with pathological findings.ResultsThe overall accuracies for T, N and M staging were (81.2%, 80.0%, and 98.9%) and (73.9%, 75.0%, and 98.9%) determined with the monochromatic images and the conventional kVp images, respectively. The improvement of the accuracy in N-staging using the keV images was statistically significant (p<0.05). The nIC values between the differentiated and undifferentiated carcinoma and between metastatic and non-metastatic lymph nodes were significantly different both in AP (p = 0.02, respectively) and PP (p = 0.01, respectively). Among metastatic lymph nodes, nIC of the signet-ring cell carcinoma were significantly different from the adenocarcinoma (p = 0.02) and mucinous adenocarcinoma (p = 0.01) in PP.ConclusionThe monochromatic images obtained with DEsCT may be used to improve the N-staging accuracy. Quantitative iodine concentration measurements may be helpful for differentiating between differentiated and undifferentiated gastric carcinoma, and between metastatic and non-metastatic lymph nodes.

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“…This remains problematic when the TNM staging based on the anatomical location would be used as a universal method of the assessment from a worldwide perspective. (7) According to the revised definition, on condition that a minimal number of the lymph nodes of 15 should be dissected, based on the number of metastatic lymph nodes, classifications were revised to N1 (the number of metastatic lymph nodes: 1~6), N2 (the number of metastatic lymph nodes: 7~15) and N3 (the number of metastatic lymph nodes: ≥16). (5,8,9) Following a comparison between the 4th edition published in 1987 and the 5th edition published in 1997, Katai et al,(10) Karpeh et al(11) and Klein Kranenbarg et al(12) reported that new classification system had a higher degree of applicability and predictability of the prognosis as compared with previous editions of the classification system.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the 7th AJCC TNM Staging System in Point of Lymph Node Classification

Kim

Kwon

2011

J Gastric Cancer

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PurposeThe 7th AJCC tumor node metastasis (TNM) staging system modified the classification of the lymph node metastasis widely compared to the 6th edition. To evaluate the prognostic predictability of the new TNM staging system, we analyzed the survival rate of the gastric cancer patients assessed by the 7th staging system.Materials and MethodsAmong 2,083 patients who underwent resection for gastric cancer at the department of surgery, Hanyang Medical Center from July 1992 to December 2009, This study retrospectively reviewed 5-year survival rate (5YSR) of 624 patients (TanyN3M0: 464 patients, TanyNanyM1: 160 patients) focusing on the number of metastatic lymph node and distant metastasis. We evaluated the applicability of the new staging system.ResultsThere were no significant differences in 5YSR between stage IIIC with more than 29 metastatic lymph nodes and stage IV (P=0.053). No significant differences were observed between stage IIIB with more than 28 metastatic lymph nodes and stage IV (P=0.093). Distinct survival differences were present between patients who were categorized as TanyN3M0 with 7 to 32 metastatic lymph nodes and stage IV. But patients with more than 33 metastatic lymph nodes did not show any significant differences compared to stage IV (P=0.055). Among patients with TanyN3M0, statistical significances were seen between patients with 7 to 30 metastatic lymph nodes and those with more than 31 metastatic lymph nodes.ConclusionsIn the new staging system, modifications of N classification is mandatory to improve prognostic prediction. Further study involving a greater number of cases is required to demonstrate the most appropriate cutoffs for N classification.

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Classification of regional lymph node metastasis from gastric carcinoma

Cited by 106 publications

References 22 publications

Impact of the latest TNM classification for gastric cancer: Retrospective analysis on 94 D2 gastrectomies

Impact of the latest TNM classification for gastric cancer: Retrospective analysis on 94 D2 gastrectomies

Gastric Cancer Staging with Dual Energy Spectral CT Imaging

Evaluation of the 7th AJCC TNM Staging System in Point of Lymph Node Classification

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