Prognostic Implications of the Seventh Edition of the International Union Against Cancer Classification for Patients With Gastric Cancer: The Western Experience of Patients Treated in a Single-Center European Institution

Reim, Daniel; Loos, Martin; Vogl, Fabian; Novotny, Alexander; Schuster, Tibor; Langer, Rupert; Becker, Karen; Höfler, Heinz; Siveke, Jens T.; Bassermann, Florian; Frieß, Helmut; Schuhmacher, Christoph

doi:10.1200/jco.2012.44.4315

Cited by 104 publications

(78 citation statements)

References 33 publications

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“…Pathological assessment of gastrectomy specimens is an essential step in the evaluation of gastric cancer patients, allowing their categorization into groups with distinct treatment and prognosis [1][2][3][4][5]24]. During this analysis, small LNs are particularly difficult to find, and missing them may negatively impact the patient's life expectancy, since even micrometastasis reduces survival [25][26][27][28][29].…”

Section: Discussionmentioning

confidence: 99%

“…Accurate staging is fundamental for prognosis and identification of those patients who should be referred for adjuvant therapy. The N status from the TNM classification strongly correlates with survival, and postoperative dissection of the specimen in the search for resected LNs should be diligently performed [1][2][3][4][5]. It is recommended that at least 16 LNs should be examined following a gastrectomy for gastric cancer [6].…”

Section: Introductionmentioning

confidence: 99%

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Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

et al. 2014

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Background Pathological examination of a minimum of 16 lymph nodes is recommended following surgery for gastric adenocarcinoma, despite this a longer survival is expected when 30 or more lymph nodes are examined. Small lymph nodes are difficult to identify, and fat-clearing solutions have been proposed to improve this, but there is no evidence of their clinical benefit. Methods Fifty D2 subtotal gastrectomy specimens were randomized for fixation in Carnoy's solution (CS) or 10 % neutral buffered formalin (NBF), with subsequent fat dissection. After dissection, the residual fat from the NBF group, instead of being discarded, was immersed in CS and dissected again. Data from 25 D2 subtotal gastrectomies performed before the study were also analyzed. Results The mean number of examined lymph nodes was 50.4 and 34.8 for CS and NBF, respectively (p \ 0.001). Missing lymph nodes were found in all cases from the residual fat group (mean of 16.9), and in eight of them (32 %) metastatic lymph nodes were present; this allowed the upstaging of two patients. Lymph nodes in the CS group were smaller than those in the NBF group (p = 0.01). The number of retrieved lymph nodes was similar among the NBF and Retrospective groups (p = 0.802). Conclusions Compared with NBF, CS increases lymph node detection following gastrectomy and allows a more accurate pathological staging. No influence of the research protocol on the number of examined lymph nodes was observed.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

et al. 2014

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“…Rannsóknin er því samhljóma nýlegum rannsókn-um sem benda til þess að það að greinast með dreifkrabbamein samkvaemt Laurén-flokkun sé sjálfstaeður áhaettuþáttur fyrir verri horfum. 22,23,26 Talsverður hluti af meinunum var ekki stiganlegur, eða 25%, annaðhvort vegna þess að sjúkraskrárnar fundust ekki eða upplýsingarnar í sjúkraskránum voru ekki fullnaegjandi. Stigun byggir á myndgreiningu með tilliti til fjarmeinvarpa og lýsingu meinafraeðings í vefjasvörum brottnumins maga sem lýsir dýpt aexlis og því hvort meinvörp séu til staðar í eitlum.…”

Section: Umraeðurunclassified

Faraldsfræði tveggja Laurén-flokka kirtilfrumukrabbameina í maga á Íslandi árin 1990-2009

Ólafsdóttir¹,

Alexíusdóttir²,

Lund³

et al. 2016

LBL

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“…Many others have also reported that N staging in 6th system is more optimal than that in the 7th system in Eastern populations [29,30,31]. Some suggest that the 7th system is more complex but does not improve the predictability for overall survival in Western populations [32,33]. In addition, there have been reports about the lack of information regarding the extent of lymph node dissection and difficulty in its application to surgical treatment planning with the N staging system.…”

Section: Uicc/ajcc Tnm Staging Systemmentioning

confidence: 99%

Gastric Cancer Staging with Radiologic Imaging Modalities and UICC Staging System

Ahn

Kim²,

Kodera

et al. 2013

Dig Surg

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There are two major stage classification systems for gastric cancer: the tumor-node-metastasis (TNM) stages by the International Union against Cancer (UICC) and the Japanese Classification of Gastric Carcinoma by the Japanese Gastric Cancer Association (JGCA). Preoperative stage classification using either of these systems is essential for deciding on the treatment strategy in the era of various multimodal therapeutic options. Evolution of multidetector computerized tomography with isotropic volumetric imaging and various 3D images has increased the accuracy of T and N staging in patients with gastric cancer, although detection of peritoneal deposits and nodal metastasis in the absence of lymphadenopathy remain problematic with the imaging tools currently available. The TNM and JGCA classifications have undergone revisions independent of each other, and the discrepancies were not helpful when international comparisons and cooperation were needed. More recently, the JGCA and TNM classifications were merged to have identical T and N categories, in addition to the more straightforward M categories that indicate the presence of distant metastasis. The result of these efforts is that researchers in Japan and the rest of the world are now looking at a similar disease when they discuss cancer that belongs to the same stage. A nomogram that incorporates other established prognostic determinants in addition to the TNM component may be a future direction for a more sophisticated means of predicting outcome. The increasing incidence of junctional (esophagogastric junction) cancer in the Far East has spurred researchers from this region to adequately stage the disease and to consider suitable treatment modalities for this disease entity, whereas Western researchers are more inclined to treat this disease as esophageal cancer. This could be an area for future international debate. For the next more accurate staging, we suggest the collaboration between Eastern and Western high-volume centers in gastric cancer because the inconsistency of surgical approaches, especially with respect to nodal resection, remains a barrier to mutual understanding.

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Prognostic Implications of the Seventh Edition of the International Union Against Cancer Classification for Patients With Gastric Cancer: The Western Experience of Patients Treated in a Single-Center European Institution

Cited by 104 publications

References 33 publications

Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

Carnoy’s solution increases the number of examined lymph nodes following gastrectomy for adenocarcinoma: a randomized trial

Faraldsfræði tveggja Laurén-flokka kirtilfrumukrabbameina í maga á Íslandi árin 1990-2009

Gastric Cancer Staging with Radiologic Imaging Modalities and UICC Staging System

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