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

Abstract

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.

AJCC Cancer Staging Manual 7th Edition Criteria for Colon Cancer: Do the Complex Modifications Improve Prognostic Assessment?

“…Several studies demonstrated that the number of examined LNs impacted survival 12-16 , and in 2007 the National Quality Forum endorsed examination of at least 12 LNs as a quality measure for CC. Subsequent studies have shown a strong correlation between outcomes and compliance with the 12-LN minimum 6, 12, 13, 17-20 . Findings of our study confirmed that examination of at least 12 LNs was associated with improved 5-year DSS and OS rates, whether CC was staged by AJCC-6 or AJCC-7 criteria.…”

Prognostic value of the seventh AJCC/UICC TNM classification of non-cardia gastric cancer

“…Although some reports have shown no difference in survival rate between patients experiencing metastasis in one to three lymph nodes compared to those with four or more lymph nodes in early gastric cancer [11,12], comparison of five-year survival rate of gastric cancer by old and new UICC stage classification suggested that metastasis in more than four lymph nodes is a significant risk factor for recurrence.…”

Sentinel Lymph Node Biopsy and Nodal Ultrastaging in Colorectal Cancer

“…[12][13][14] Although patient factors such as age and sex, tumor factors such as grade and site, and surgical technique can affect the number of lymph nodes retrieved, 15 if fewer than 12 lymph nodes are initially identified, it is recommended that the pathologist should reexamine the tissue and conduct a more extensive search for lymph nodes. 17 Subsequent studies supported this correlation between outcomes and adherence to the 12-lymph-node minimum, [17][18][19][20][21][22][23] and findings in the Hari et al 4 study confirmed that examination of at least 12 lymph nodes was associated with improved 5-year DSS and OS rates irrespective if staging was based on the sixth or seventh edition of the AJCC Cancer Staging Manual. 16 Our group's analysis of SEER data confirmed that increased nodal sampling was associated with improved survival.…”