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

Abstract

BackgroundThe TNM staging criteria for gastric carcinoma have seen numerous revisions, the most recent of which are reflected in the seventh edition AJCC TNM cancer staging manual.MethodsA retrospective evaluation of the sixth and seventh TNM classification of gastric cancer on a prospective database, regarding patients operated on for primary gastric cancer, was conducted. The end point of the study was prognosis evaluation in terms of overall survival.Patients operated on for primary gastric cancer between September 2003 and March 2012 at our Department of Emergency and General Surgery, were consecutively retrieved in this study; a total of 114 patients were considered. Cardia gastric cancers, gastric lymphomas and gastrointestinal stromal tumors (GIST) were excluded. Median and mean follow-up periods were 22.5 and 27.7 months (range 15 days to 5 years). Both TNM6 and TNM7 were used to evaluate our patients. Overall survival and survival rates at different stages were analyzed using the Kaplan-Meier method and differences were determined using a log-rank test. Cox’s proportional hazard model was used to identify significant factors related to prognosis in a multivariate analysis.ResultsOverall survival between the sixth and seventh TNM classification was not significantly different. Both the Kaplan-Meier analysis and the multivariate analysis showed that the major negative prognostic factor was lymphovascular invasion (P < 0.001 in the univariate analysis and P = 0.035 to 0.048 in the multivariate analysis). Stage distribution and stage-related survival changed from the sixth to the seventh edition, especially in T3 stage where median survival for the sixth edition was 720 days versus 1,200 days for the seventh edition. Moreover, differences were shown in the survival rate of N1 versus N2 stages within the seventh TNM.ConclusionsEven though further studies are needed in order to increase the number of patients studied, the seventh edition seems to provide a more accurate prognosis, especially regarding N1 and N2 tumors, showing that the most important prognostic factor is lymphovascular invasion.

Pathobiological Characteristics of Intestinal and Diffuse-Type of Gastric Carcinoma-Retrospective Study of Gastric Cancers

“…This shows that Younger patients had a higher incidence of lymph node metastasis of gastric cancer of diffuse type, but not for the intestinal type. Results of the present study was in accordance with other studies, [6,10,11] gastric cancer was most common in 5 th to 6 th decade. Male: female ratio was 2:1.…”

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

“…These changes included reclassification of T2a and T2b to T2 and T3, respectively; division of the previous N1 stage (up to 6 metastatic regional lymph nodes) into N1 (1 or 2 metastatic regional lymph nodes) and N2 (3 to 6 metastatic regional lymph nodes); and reclassification of the previous N2 (7 to 15 metastatic regional lymph nodes) and N3 stages (more than 15 metastatic regional lymph nodes) to N3a (7 to 15 metastatic regional lymph nodes) and N3b (more than 15 metastatic regional lymph nodes) [234]. 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].…”

Whole‐volume apparent diffusion coefficient‐based entropy parameters for assessment of gastric cancer aggressiveness

“…Based on GLOBOCAN estimates, 951,600 new stomach cancer cases and 723,100 deaths occurred in 2012 worldwide . Basic histopathological indexes, including tumor, node, and metastasis (TNM) staging, differentiation degree, Lauren classification, vascular and perineural invasion, are commonly used to characterize the aggressiveness of gastric cancers . However, most of this information can only be obtained through postoperative specimens.…”