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

Abstract

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%.

Prognostic indicators in locally advanced gastric cancer (LAGC) treated with preoperative chemotherapy and D2-gastrectomy

“…It remains to be proved if this could imply that the prognosis of patients with only a few lymph node metastases would be improved by extending lymph node dissection, thus reducing the ratio of invaded to removed nodes. In our series, the minimum number of lymph nodes removed per patient was 21, in all cases well above the minimum of 16 nodes previously indicated by us [42] as a prerequisite for correct N-staging of gastric cancer.…”

“…Postoperative follow-up was planned for all patients at the following intervals: 3,6,9,12,15,18,21,24,30,36,42,48, and 60 months after surgery. Postoperative evaluation included clinical history, physical examination, complete blood count, and blood serum analysis, endoscopy (every 6 months in the first year and once a year thereafter), abdominal ultrasound (every 3 months in the first year and every 6 months thereafter), chest X-ray, and abdominopelvic CT (every year).…”

Clinical significance of detecting elevated serum DcR3/TR6/M68 in malignant tumor patients

“…More interestingly, the serum TR6 levels seem to have a prognostic value in gastric carcinomas because TNM is a quite reliable prognostic parameter for gastric carcinomas16 and serum TR6 levels were correlated with TNM stages, especially when the patients were grouped into ≤ T2/N1/M0 vs. ≥ T3/N2/M1. The correlation between TR6 serum levels and the N stages has especially useful clinical application.…”

The effectiveness of the new (7th) UICC N classification in the prognosis evaluation of gastric cancer patients: a comparative study between the 5th/6th and 7th UICC N classification

“…The TNM system is accepted as a golden standard for the staging system of malignancy all over the world. The depth of primary tumor infiltration and number of metastatic lymph nodes (LNs) are known to be the most important prognostic factors of gastric cancer after curative surgery [3][4][5][6][7]. Especially the extent of LN metastasis is considered to be the most important independent prognostic factor [8,9].…”