Journal List > J Korean Surg Soc > v.80(1) > 1011258

Bae, Kim, Kim, and Song: Evaluation of Prognostic Values according to the New TNM Classification in Gastric Cancer

Abstract

Purpose

In 2010, the new UICC/AJCC TNM classification for gastric cancer was declared. The new classification for gastric cancer has several changes from the 6th classification. We evaluated the prognostic values and differences according to the new UICC/AJCC TNM classification.

Methods

From 2000 to 2004, 1,196 patients who underwent curative resection with D1+β or more lymph node dissection and with 15 or more lymph nodes retrieved were studied retrospectively. We analyzed clinical characteristics and survival outcomes retrospectively from medical records.

Results

According to UICC/AJCC 7th TNM classification, the 5-year survival rate (5YSR) of each group for depth of invasion and node metastasis were significantly different. The 5YSR of stage II in 6th classification was 82.4% and the 5YSR of stage IIa and IIb in 7th classification were 92.2% and 82.9%. The 5YSR of stage IIIa and IIIb in 6th classification were 56.3% and 33.0%. The 5YSR of stage IIIa, IIIb and IIIc in 7th classification were 72.7%, 48.4% and 26.1%. In our Cox regression multivariate analysis, N stage of the 6th UICC/AJCC TNM classification was the main independent prognostic factor.

Conclusion

N stage of the 6th UICC/AJCC TNM classification is a more reliable prognostic factor than N stage of the 7th UICC/AJCC TNM classification. Further study should be performed to confirm the appropriateness of N stage TNM classification for gastric cancer.

Figures and Tables

Fig. 1
Survival curves of patients according to T stage of UICC/AJCC 6th.
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Fig. 2
Survival curves of patients according to T stage of UICC/AJCC 7th.
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Fig. 3
Survival curves of patients according to N stage of UICC/AJCC 6th.
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Fig. 4
Survival curves of patients according to N stage of UICC/AJCC 7th.
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Fig. 5
Survival curves of patients according to TNM stage of UICC/AJCC 6th.
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Fig. 6
Survival curves of patients according to TNM stage of UICC/AJCC 7th.
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Table 1
Clinicopathologic characteristics of gastric cancer patients
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Table 2
Comparison of 5 year survival rate of gastric cancer patients according to the AJCC stages
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Table 3
Distribution of patients according to the T and N stages: the number of patients and 5 year survival rate were specified
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5 year survival rate was calculated if number of gastric cancer patient were more than 10.

Table 4
Multivariate analysis according to Cox proportional hazard model
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References

1. Edge SB. American Joint Committee on Cancer. AJCC cancer staging manual. 2010. 7th ed. New York: Springer.
2. Greene FL. American Joint Committee on Cancer. American Cancer Society. AJCC cancer staging manual. 2002. 6th ed. New York: Springer.
3. Lu Y, Liu C, Zhang R, Li H, Lu P, Jin F, et al. Prognostic significance of subclassification of pT2 gastric cancer: a retrospective study of 847 patients. Surg Oncol. 2008. 17:317–322.
4. Choi BH, Kim JH, Kwak JH, Jang HJ, Han MS. The analysis of clinical characteristics of pT2a and pT2b gastric cancer. J Korean Surg Soc. 2009. 77:257–261.
5. 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. 141:757–763.
6. Ishigami S, Natsugoe S, Miyazono F, Hata Y, Uenosono Y, Sumikura S, et al. Clinical merit of subdividing gastric cancer according to invasion of the muscularis propria. Hepatogastroenterology. 2004. 51:869–871.
7. Deng J, Liang H, Sun D, Wang D, Pan Y. Suitability of 7th UICC N stage for predicting the overall survival of gastric cancer patients after curative resection in China. Ann Surg Oncol. 2010. 17:1259–1266.
8. Ha TK, Kim HJ, Kwon SJ. Does the New UICC/AJCC TNM Staging System (7th Edition) Improve Assessing Prognosis in Gastric Cancer Compared to the Old System (6th Edition)? J Korean Gastric Cancer Assoc. 2009. 9:159–166.
9. Huang B, Zheng X, Wang Z, Wang M, Dong Y, Zhao B, et al. Prognostic significance of the number of metastatic lymph nodes: is UICC/TNM node classification perfectly suitable for early gastric cancer? Ann Surg Oncol. 2009. 16:61–67.
10. Roviello F, Rossi S, Marrelli D, Pedrazzani C, Corso G, Vindigni C, et al. Number of lymph node metastases and its prognostic significance in early gastric cancer: a multicenter Italian study. J Surg Oncol. 2006. 94:275–280. discussion 4.
11. Gunji Y, Suzuki T, Hori S, Hayashi H, Matsubara H, Shimada H, et al. Prognostic significance of the number of metastatic lymph nodes in early gastric cancer. Dig Surg. 2003. 20:148–153.
12. Zhang X, Watson DI, Jamieson GG. Lymph node metastases of adenocarcinoma of the esophagus and esophagogastric junction. Chin Med J (Engl). 2007. 120:2268–2270.
13. Deng JY, Liang H, Sun D, Zhan HJ, Wang XN. The most appropriate category of metastatic lymph nodes to evaluate overall survival of gastric cancer following curative resection. J Surg Oncol. 2008. 98:343–348.
14. Seo YJ, Bae JM, Kim SW, Kim SW, Song SK. Different clinical outcomes of stage IV gastric cancer according to the curability of surgery. J Korean Surg Soc. 2009. 77:170–176.
15. Ha TK, Kwon SJ. Subclassification of stage IV gastric cancer according to the presence of distant metastasis (IVa and IVb). J Korean Gastric Cancer Assoc. 2006. 6:173–180.
16. An JY, Ha TK, Noh JH, Sohn TS, Kim S. Proposal to subclassify stage IV gastric cancer into IVA, IVB, and IVM. Arch Surg. 2009. 144:38–45. discussion 45.
17. Li C, Yan M, Chen J, Xiang M, Zhu ZG, Lin YZ. Prognostic influence of sub-stages according to pTNM categories in patients with stage IV gastric cancer. J Surg Oncol. 2009. 99:324–328.
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