Comparison of the 6th and 7th editions of the AJCC/UICC TNM staging system for gastric cancer focusing on the “N” parameter-related survival: the monoinstitutional NodUs Italian study

World Journal of Surgical Oncology

Natale Di Martino¹  Giuseppe Izzo¹  Angelo Cosenza¹  Michele Schettino¹  Angela Romano¹  Gianmarco Reda¹  Raffaele Porfidia¹  Modestino Pezzella¹  Marianna Petrillo¹  Michele Grassia¹  Giuseppe Esposito¹  Bartolomeo Braccio¹  Virginia Boccardi¹  Luigi Marano¹ 

[1] 8th General and Gastrointestinal Surgery, Department of Internal Medicine, Surgical, Neurological Metabolic Disease and Geriatric Medicine, Second University of Naples, Piazza Miraglia 2, Naples, 80138, Italy

关键词: 6th TNM;    7th TNM;    Lymph node status;    Staging system;    Gastric cancer;   

Others  :  1221216
DOI  :  10.1186/s12957-015-0633-3

 received in 2015-03-07, accepted in 2015-06-25,  发布年份 2015

【 摘 要 】

Background

A large number of Asian population studies examined the difference between the 6th and the 7th tumor, node, metastasis (TNM) while it is still poorly validated among Caucasian populations. This is a retrospective study aimed at investigating the efficacy of the 7th edition American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging system for gastric cancer focusing on the “N” parameter-related survival for prognostic assessment in gastric cancer patients of a single Western high-volume institution.

Methods

From January 2002 to December 2009, the data of 274 patients with gastric cancer who underwent gastric surgery at the 8th General and Gastrointestinal Surgical Centre of the Second University of Naples were analyzed retrospectively. We collected data for patient demographics, tumor characteristics, surgical characteristics, and TNM stage. Particularly, the nodal status, with the number of dissected nodes and metastatic nodes, was reviewed from the pathology records. The same patient dataset was used to stage patients according to both the 6th and 7th edition criteria.

Results

Age at surgery, tumor location, histological grade, Lauren’s classification subtypes, and 6th and 7th AJCC/UICC N categories were found to have statistically significant associations with overall survival on univariate analysis. In the 6th edition staging system, the Kaplan–Meier plot did not show significant overlapped survival curves: significant differences were found between N0 and N1, P < .001; N1 and N2, P = .04; and N2 and N3, P < .001. On the contrary, in the 7th edition, among all five substages, there were similar survival curves between N categories 2 and 3a (P = .98) with a statistically significant discriminatory ability only between N1 versus N3b and N2 versus N3b (P = .02 and .04, respectively).

Conclusions

Based on analysis, we found that several clinicopathological variables, especially histological grade and Lauren’s classification, were significant prognostic factors in our database. The 6th and 7th AJCC/UICC N classifications represent significantly independent prognostic factors, and the 6th AJCC/UICC N classification seems to be superior to the 7th AJCC/UICC N classification in terms of uniformity, differentiation, and monotonicity of gradients.

【 授权许可】

   
2015 Marano et al.

【 图 表 】

Fig. 1.

Fig. 2.

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