Comparison of the 6th and 7th editions of the AJCC/UICC TNM staging system for gastric cancer focusing on the “N” parameter-related survival: the monoinstitutional NodUs Italian study

Marano, Luigi; Boccardi, Virginia; Braccio, Bartolomeo; Esposito, Giuseppe; Grassia, Michele; Petrillo, Mauro; Pezzella, Modestino; Porfidia, Raffaele; Reda, Gianmarco; Romano, Adriana; Schettino, Maria Teresa; Cosenza, Angelo; Izzo, Giuseppe; Martino, Natale Di

doi:10.1186/s12957-015-0633-3

Cited by 52 publications

(47 citation statements)

References 28 publications

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“…Patients with lymph node metastases and/or ≥ T3 tumor were recommended perioperative chemotherapy with standardized regimens (5-FU, epirubicin and cisplatin [9,10] or docetaxel, cisplatin, and capecitabin [11] ). For tumor staging, the 7th edition of the American Joint Committee on Cancer/Union for International Cancer Control (UICC) staging system was applied [12] . Gastrectomy was considered in patients with biopsy-proven gastric malignancy without clinical suspicion of distant metastases.…”

Section: Preoperative Assessmentmentioning

confidence: 99%

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

et al. 2016

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Background: Obesity is generally considered to be associated with increased postoperative morbidity and mortality following intraabdominal cancer surgery. However, recent reports showed that overweight patients may have a lower risk for adverse postoperative outcomes and this observation has been described as the ‘obesity paradox'. Therefore, we aimed to analyze the impact of obesity on outcomes after resection for gastric cancer. Methods: Data of patients who underwent resection for gastric cancer between 2005 and 2012 were assessed. Patient characteristics, postoperative outcomes and long-term survivals were compared between patients with body mass index (BMI) ≥30 and <30. Results: Resection for gastric cancer was performed in 249 patients. BMI ≥30 was identified in 49 patients. Obese patients with BMI ≥30 were more frequently diagnosed with diabetes (31 vs. 16%, p = 0.015). Resection for gastric cancer in obese patients was significantly associated with longer duration of surgery (278 vs. 243 min, p < 0.001), longer duration of hospital stay (18 vs. 16 days, p = 0.028), increased postoperative morbidity (49 vs. 33%, p = 0.037), and increased postoperative mortality (10 vs. 3%, p = 0.028). There was no significant difference in overall survival (OS) between patients with BMI ≥30 and patients with BMI <30 (5-year OS rate: 59 vs. 62%, p = 0.587). Conclusion: Obesity may complicate resection for gastric cancer increasing the duration of surgical procedure, hospital stay and postoperative morbidity and mortality. However, BMI did not predict OS in our patients. Consequently, BMI may be too simple as a parameter to evaluate sophisticated interactions between different body fat compartments and inflammatory and immune responses and thus to predict long-term oncologic outcomes.

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Section: Preoperative Assessmentmentioning

confidence: 99%

The Impact of Obesity on Outcomes Following Resection for Gastric Cancer

et al. 2016

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“…Although the 7th AJCC/UICC staging system for gastric cancer has been reported to be more accurate or valid by some authors [3567], the system is not without controversy. One of the most common controversies is classification of the N category, such that the discriminative power of the N category in the 7th UICC/AJCC staging system has been decreased relative to that of the 6th AJCC/UICC staging system [89]. In addition, different prognostic significances of the subgroups of N3 (N3a and N3b) was not reflected in the final staging [1011].…”

Section: Introductionmentioning

confidence: 99%

Validation of the 7th AJCC/UICC staging system for gastric cancer and a proposal for a new TNM system based on a prognostic score: a retrospective multicenter study

et al. 2016

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PurposeWe validate the 7th American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) staging system for gastric cancer and propose a new staging system that reflects the prognostic significances of each of T and N category.MethodsData from 5,957 patients who underwent curative gastrectomies from 2000 to 2007 at 4 university hospitals in Daegu Metropolitan city in Korea were analyzed for the validation of the 7th AJCC/UICC staging system for gastric cancer. The hazard ratios of the respective T and N categories were estimated and converted to weightings and summated to make prognostic score (P-score). Homogeneity and stage grouping were determined according to the P-scores.ResultsIn the 7th AJCC/UICC staging system for gastric cancer, poor discrimination was noted between stages IIB and IIIA (P = 0.152). In addition, heterogeneity in stage IIB (P = 0.021) and a small gap in 5-year survival rates (1.7%) between stages IA and IB were noted. A new proposed staging system was generated on the basis of P-scores and demonstrated more discrimination between stages and more homogeneity within stages. The new staging system reflects the different prognostic impacts of N3a and N3b.ConclusionSeveral controversial issues of the 7th AJCC/UICC staging system for gastric cancer were reconfirmed in the present analysis. The TNM system based on P-score appears to be more scientifically accurate than the 7th AJCC/UICC staging system for gastric cancer.

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“…Recently, an updated systematic study on the global burden of diseases demonstrated that the number of global deaths from gastric cancer was 738 000 (9.7% of the total) in 2008 . It is widely known that it is important to diagnose EGC, which is closely related to the high 5‐year survival rate for gastric cancer . With the growing role of endoscopic submucosal dissection and endoscopic mucosal resection for EGC and parts of PGLs, the importance of the diagnostic efficacy of endoscopy should receive more attention …”

Section: Discussionmentioning

confidence: 99%