Abstract
Background
To investigate the validity of the 7th edition of American Joint Committee on Cancer (AJCC) TNM staging system for gastric cancer with special attention paid to pT2/pT3, pN1/pN2, and pN3a/pN3b category.
Materials and Methods
Clinicopathologic data of 1998 patients underwent R0 surgery for histologically proven gastric cancers with >15 lymph nodes retrieved were retrospectively reviewed.
Results
Prognoses were significantly different between pT2 and pT3 categories, between pN1 and pN2 categories, or between pN3a and pN3b categories. Each stage in the 6th edition was divided into the 7th edition stage with different survival rates. Moreover, stage IIIA, IIIB, and IIIC in the 7th edition system was divided into the 6th edition stage with different survival rates. Prognoses for patients in 7th edition T4aN1M0/T3N2M0/T2N3aM0, T4bN0-1M0/T4aN2M0/T3N3aM0, and T4aN3aM0/T4bN2M0 were similar to that of patients in T1N3bM0, T2N3bM0, and T3N3bM0, respectively, but significantly better than that of patients in T2N3bM0, T3N3bM0, and T4aN3bM0, respectively. However, no significant difference could be observed among patients in T4bN3aM0, T4aN3bM0, T4bN3bM0, and stage IV. A revised TNM system was proposed, in which T1N3bM0 was incorporated into stage IIIA, T2N3bM0 into stage IIIB, T3N3bM0 into stage IIIC, T4bN3aM0/T4aN3bM0/T4bN3bM0 into stage IV. Further analyses revealed the revised TNM system had better homogeneity, discriminatory ability, and monotonicity of gradients than the 6th and the 7th edition system.
Conclusions
It is reasonable to subclassify the 6th edition pT2 category and pN1 category into the 7th edition pT2/pT3 category and pN1/pN2 category, respectively. However, for better prognostic stratification, it might be more suitable for pN3a and pN3b categories to be considered individual determinants of the 7th edition TNM staging system.
Similar content being viewed by others
References
Goggins WB, Wong GK. Poor survival for US Pacific Islander cancer patients: evidence from the Surveillance, Epidemiology, and End Results database: 1991 to 2004. J Clin Oncol. 2007;25:5738–41.
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58:71–96.
Crew KD, Neugut AI. Epidemiology of gastric cancer. World J Gastroenterol. 2006;12:354–62.
Dicken BJ, Bigam DL, Cass C, Mackey JR, Joy AA, Hamilton SM. Gastric adenocarcinoma: review and considerations for future directions. Ann Surg. 2005;241:27–39.
Kim JP, Lee JH, Kim SJ, Yu HJ, Yang HK. Clinicopathologic characteristics and prognostic factors in 10,783 patients with gastric cancer. Gastric Cancer. 1998;1:125–33.
Greene FL, Page AL, Fleming ID, Fritz A, Balch CM, Haller DG, et al., eds. American Joint Committee on Cancer: AJCC Cancer Staging Manual. 6th ed. New York: Springer, 2002:99–106.
Nitti D, Marchet A, Mocellin S, Rossi GM, Ambrosi A, Mencarelli R. Prognostic value of subclassification of T2 tumours in patients with gastric cancer. Br J Surg. 2009;96:398–404.
Park do J, Kong SH, Lee HJ, Kim WH, Yang HK, Lee KU, et al. Subclassification of pT2 gastric adenocarcinoma according to depth of invasion (pT2a vs pT2b) and lymph node status (pN). Surgery. 2007;141:757–63.
Sun Z, Zhu GL, Lu C, Guo PT, Huang BJ, Li K, et al. A novel subclassification of pT2 gastric cancers according to the depth of muscularis propria invasion: superficial muscularis propria versus deep muscularis propria/subserosa. Ann Surg. 2009;249:768–75.
Bouvier AM, Haas O, Piard F, Roignot P, Bonithon-Kopp C, Faivre J. How many nodes must be examined to accurately stage gastric carcinomas? Results from a population based study. Cancer. 2002;94:2862–6.
Sun Z, Zhu GL, Lu C, Guo PT, Huang BJ, Li K, et al. The impact of N-ratio in minimizing stage migration phenomenon in gastric cancer patients with insufficient number or level of lymph node retrieved: results from a Chinese mono-institutional study in 2159 patients. Ann Oncol. 2009;20:897–905.
Sun Z, Xu Y, Li DM, Wang ZN, Zhu GL, Huang BJ, et al. Log odds of positive lymph nodes: a novel prognostic indicator superior to the number based and the ratio based N staging system for gastric cancer patients with R0 resection. Cancer. 2010;116:2571–80.
Sobin LH, Gospodarowicz MK, Wittekind C. International Union Against Cancer (UICC) TNM Classification of Malignant Tumours. 7th ed. New York: Wiley-Liss; 2010.
Ahn HS, Lee HJ, Hahn S, Kim WH, Lee KU, Sano T, et al. Evaluation of the Seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification. Cancer. 2010;116:5592–8.
Wang W, Sun XW, Li CF, Lv L, Li YF, Chen YB, et al. Comparison of the 6th and 7th Editions of the UICC TNM Staging System for Gastric Cancer: results of a Chinese single-institution study of 1,503 patients. Ann Surg Oncol. 2011;18:1060–7.
Jung H, Lee HH, Song KY, Jeon HM, Park CH. Validation of the seventh edition of the american joint committee on cancer TNM staging system for gastric cancer. Cancer. 2011;117:2371–8.
Katai H, Yoshimura K, Maruyama K, Sasako M, Sano. Evaluation of the New International Union Against Cancer TNM staging for gastric carcinoma. Cancer. 2000;88:1796–800.
Saito H, Fukumoto Y, Osaki T, Fukuda K, Tatebe S, Tsujitani S, et al. Prognostic significance of level and number of lymph node metastases in patients with gastric cancer. Ann Surg Oncol. 2007;14:1688–93.
Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D, et al. The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007;245:543–52.
Ueno S, Tanabe G, Sako K, Hiwaki T, Hokotate H, Fukukura Y, et al. Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program. Hepatology. 2001;34:529–34.
Stone M. Akaike’s criteria. In: Armitage P, Colton T, eds. Encyclopedia of Biostatistics. Chichester: Wiley; 1998:123–4.
Kee KM, Wang JH, Lee CM, Chen CL, Changchien CS, Hu TH, et al. Validation of clinical AJCC/UICC TNM staging system for hepatocellular carcinoma: analysis of 5,613 cases from a medical center in southern Taiwan. Int J Cancer. 2007;120:2650–5.
Cho YK, Chung JW, Kim JK, Ahn YS, Kim MY, Park YO, et al. Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Cancer. 2008;112:352–61.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti III., eds. AJCC—Cancer Staging Handbook. 7th ed. New York: Springer-Verlag; 2010.
Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ, Welvaart K, Songun I, et al. Extended lymph-node dissection for gastric cancer. N Engl J Med. 1999;340:908–14.
Roviello F, Marrelli D, Morgagni P, de Manzoni G, Di Leo A, Vindigni C, et al. Survival benefit of extended D2 lymphadenectomy in gastric cancer with involvement of second level lymph nodes: a longitudinal multicenter study. Ann Surg Oncol. 2002;9:894–900.
Wu CW, Hsiung CA, Lo SS, Hsieh MC, Chen JH, Li AF, et al. Stage migration influences on stage-specific survival comparison between D1 and D3 gastric cancer surgeries. Eur J Surg Oncol. 2005;31:153–7.
Acknowledgment
Supported by grants from the National Natural Science Foundation of China (No. 30901419, 81071956).
Conflict of interest
The authors declare that they have no competing interests.
Author information
Authors and Affiliations
Corresponding authors
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Sun, Z., Wang, Zn., Zhu, Z. et al. Evaluation of the Seventh Edition of American Joint Committee on Cancer TNM Staging System for Gastric Cancer: Results from a Chinese Monoinstitutional Study. Ann Surg Oncol 19, 1918–1927 (2012). https://doi.org/10.1245/s10434-011-2206-1
Received:
Published:
Issue Date:
DOI: https://doi.org/10.1245/s10434-011-2206-1