Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems

Ikeguchi, Masahide; Murakami, Daiki; Kanaji, Shingo; Ohro, Shotaro; Maeta, Yoshihiko; Yamaguchi, Kensei; Tatebe, Shigeru; Kondo, Akira; Tsujitani, Shunichi; Kaibara, Nobuaki

doi:10.1111/j.1445-1433.2004.03188.x

Cited by 18 publications

(14 citation statements)

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“…Although the 6 th edition of the American Joint Committee on Cancer (AJCC) TNM classification is an excellent classification system and has been extensively used for gastric cancer staging worldwide (Greene, 2002), different lymph node staging systems between the Japanese Gastric Cancer Association (JGCA) classification and the AJCC classification had made it difficult to compare treatment outcomes in an international setting (Japanese, 1998;Ikeguchi et al, 2004;Aurello et al, 2007). In Aug, 19 th , 2008, the member of AJCC, UICC and JGCA held the World Cancer Congress in Buffalo, New York, which aimed to revise and unify stage system of gastric cancer.…”

Section: Introductionmentioning

confidence: 99%

Validity and Necessity of Sub-classification of N3 in the 7^thUICC TNM Stage of Gastric Cancer

Zhang

Liang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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Background: The 7 th TNM staging is the first authoritative standard for evaluation of effectiveness of treatment of gastric cancer worldwide. However, revision of pN classification within TNM needs to be discussed. In particular, the N3 sub-stage is becoming more conspicuous. Methods: Clinical data of 302 pN3M0 stage gastric cancer patients who received radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital from January 2001 to May 2006 were retrospectively analyzed. Results: Location of tumor, depth of invasion, extranodal metastasis, gastric resection, combined organs resection, lymph node metastasis, rate of lymph node metastasis, negative lymph nodes count were important prognostic factors of pN3M0 stage gastric cancers. TNM stage was also associated with prognosis. Patients at T2N3M0 stage had a better prognosis than other sub-classification. T3N3M0 and T4aN3aM0 patients had equal prognosis which followed the T2N3M0. T4aN3bM0 and T4bN3aM0 had lower survival rate than the formers. T4bN3bM0 had worst prognosis. In multivariate analysis, TNM stage group and rate of lymph node metastasis were independent prognostic factors. Conclusions: The sub-stage of N3 may be useful for more accurate prediction of prognosis; it should therefore be applied in the TNM stage system.

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Section: Introductionmentioning

confidence: 99%

Validity and Necessity of Sub-classification of N3 in the 7^thUICC TNM Stage of Gastric Cancer

Zhang

Liang³

et al. 2013

Asian Pacific Journal of Cancer Prevention

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“…3,4 However, limitations such as lack of information regarding the extent of lymph node dissection and difficulty in its application to surgical treatment planning have been demonstrated as disadvantages of a numeric classification system. [5][6][7] Moreover, to the best of our knowledge, there has been no consensus regarding the adequate grouping of lymph node staging. Another current issue in gastric cancer staging concerns the classification of depth of invasion, especially for the pT2 classification.…”

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confidence: 99%

Validation of the seventh edition of the American Joint Committee on Cancer TNM staging system for gastric cancer

Jung

Lee

Song

et al. 2011

Cancer

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BACKGROUND:The seventh edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer was published in 2010 and included major revisions. The aim of the current study was to evaluate the validity of the seventh edition TNM classification for gastric cancer based on an Asian population. METHODS: A total of 2916 gastric cancer patients who underwent R0 surgical resection from 1989 through 2008 in a single institute were included, and were analyzed according to the seventh edition of the TNM classification for validation. RESULTS: When adjusted using the seventh edition of the TNM classification, upstaging was observed in 771 patients (26.4%) and downstaging was observed in 178 patients (6.1%) compared with the sixth edition of the TNM classification. The relative risk (RR) of seventh edition pT classification was found to be increased with regular intensity compared with the sixth edition pT classification. The RR of seventh edition pN classification was found to be increased with irregular intensity compared with the sixth edition pN classification. In survival analysis, there were significant differences noted for each stage of disease, but only a marginal difference was demonstrated between stage IA and stage IB (P ¼ .049). In the hybrid TNM classification, which combines the seventh edition pT classification and the sixth edition pN classification, both pT and pN classifications demonstrated a more ideal distribution of the RR, and 5-year survival rates also showed a significant difference for each stage (P <.01). CONCLUSIONS: The seventh edition of the TNM classification was considered valid based on the results of the current study. However, the hybrid TNM classification, comprised of a combination of the seventh edition pT classification and sixth edition pN classification, should be considered for the next edition.

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“…The defi nition proposed by the AJCC/UICC is based on the absolute number of positive lymph nodes, while that put forward by the JGCA is based on the location of positive lymph nodes. Advantages exist in both systems [1,3] . Recently, a growing body of evidence in the literature [4][5][6] suggests that the AJCC/UICC staging system may predict prognosis more precisely and that the rate of positive lymph nodes is an independent predictive factor of prognosis [7][8][9] .…”

Section: Discussionmentioning

confidence: 96%

“…The definition of regional lymph nodes is the principal difference and the main controversy [1,2] . The defi nition proposed by the AJCC/UICC is based on the absolute number of positive lymph nodes, while that put forward by the JGCA is based on the location of positive lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of the number of negative lymph nodes in postoperative locally advanced gastric cancer patients

Teng

Dong

2009

Clin. Oncol. Cancer Res.

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OBJECTIVE To evaluate the impact of the number of negative lymph nodes on disease free survival (DFS) in patients with locally advanced gastric cancer. METHODS A total of 485 patients who underwent surgery for locally advanced gastric cancer (pT3N0-2M0) and had a DFS at least 6 months were enrolled in this retrospective study. The medical records of the patients were reviewed in detail, and the characteristics of the patients and the findings of pathologic examination were analyzed in order to find the potential association with DFS. Subgroup analysis according to pathologic stage was performed. Multivariate analysis using the COX regression method was also conducted in order to identify the independent prognostic factors. The Kaplan-Meier method was used to plot DFS curves. The DFS rate was compared in each subgroup. RESULTS COX regression analysis showed that the DFS rate of gastric cancer patients with pathologic stage T3N0-2M0 was signifi cantly associated with age, degree of tumor diff erentiation, tumor location as well as the number of negative lymph nodes. Among patients with stage T3N0M0 disease, who had 1-4 and 5 or more negative lymph nodes, the 2-year DFS rate was 8.3% and 55.6%, respectively. Meanwhile, the 3-year DFS rates of the same group of patients was 0% and 24.9%, respectively (P = 0.025). In the T3N1M0 subgroup, the 2-year DFS rate of patients with 3 or fewer, 4-9, and 10 or more negative lymph nodes was 17.3%, 39.1%, 52.6%, respectively. The 3-year DFS rate in this group was 4.2%, 6.0%, 17.1%, respectively (P < 0.001). In the T3N2M0 subgroup, the 2-year DFS rate of patients with 7 or fewer and 8 or more negative lymph nodes was 11.5% and 35%, respectively. The 3-year DFS rate of the same group of patients with 8 or more negative lymph nodes was also significantly improved (0.8% vs. 5%, respectively; P = 0.015). CONCLUSION For gastric cancer patients with pathologic stage T3N0-2M0, the number of negative lymph nodes is an independent prognostic factor for DFS. The number of negative lymph nodes may reflect the level of regional lymph node dissection or the accuracy of the pathologic staging.

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Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems

Abstract: The JGCA system is more suitable for estimating the prognosis of Japanese patients with advanced GC than the UICC-TNM.

Cited by 18 publications

References 10 publications

Validity and Necessity of Sub-classification of N3 in the 7^thUICC TNM Stage of Gastric Cancer

Validity and Necessity of Sub-classification of N3 in the 7^thUICC TNM Stage of Gastric Cancer

Validation of the seventh edition of the American Joint Committee on Cancer TNM staging system for gastric cancer

Prognostic significance of the number of negative lymph nodes in postoperative locally advanced gastric cancer patients

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Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems

Abstract: The JGCA system is more suitable for estimating the prognosis of Japanese patients with advanced GC than the UICC-TNM.

Cited by 18 publications

References 10 publications

Validity and Necessity of Sub-classification of N3 in the 7thUICC TNM Stage of Gastric Cancer

Validity and Necessity of Sub-classification of N3 in the 7thUICC TNM Stage of Gastric Cancer

Validation of the seventh edition of the American Joint Committee on Cancer TNM staging system for gastric cancer

Prognostic significance of the number of negative lymph nodes in postoperative locally advanced gastric cancer patients

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Validity and Necessity of Sub-classification of N3 in the 7^thUICC TNM Stage of Gastric Cancer

Validity and Necessity of Sub-classification of N3 in the 7^thUICC TNM Stage of Gastric Cancer