Abstract
Background: The need for a precise lymph node staging without stage migration is of paramount importance when comparing and evaluating international treatment results.
Methods: We reviewed 1019 patients who underwent R0 resection at Kansai Medical University between 1980 and 1997. The patients were classified according to the 1997 International Union Against Cancer (UICC)/American Joint Committee on Cancer (AJCC) pN classification or the N staging depending on the ratio between the number of excised and the number of involved lymph nodes (pN1, ≤25%; pN2, ≤50%; pN3, >50%).
Results: Among the 1997 UICC/AJCC pN subgroups, prognosis worsened with an increase in lymph node ratio. In contrast, the ratio-based classification showed more homogenous survival according to the number of involved lymph nodes. Multiple stepwise regression analysis showed that the ratio-based classification was the most significant prognostic factor, whereas the 1997 UICC/AJCC classification was not found to be an independent predictor of survival. In addition, the ratio-based classification showed a superiority to the 1997 UICC/AJCC classification with respect to stage migration.
Conclusions: Ratio-based lymph node staging is simple and gives more precise information for prognosis with fewer problems related to stage migration than the 1997 UICC/AJCC staging system.
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References
Sobin LH, Wittekind CH.International Union Against Cancer (UICC). TNM Classification of Malignant Tumours. 5th ed. New York: Wiley, 1997.
Fleming ID, Cooper JS, Henson DE, et al. eds.Manual for Staging of Cancer. American Joint Committee on Cancer. 5th ed. Philadelphia: JB Lippincott, 1997.
Japanese Research Society for Gastric Cancer.Japanese Classification of Gastric Carcinoma. 1st English ed. Tokyo: Kanehara & Co., Ltd., 1995.
Japanese Gastric Cancer Association.Japanese Classification of Gastric Carcinoma. 2nd English ed.Gastric Cancer 1998;1:10–14.
Hermanek P, Sobin LH, eds.UICC TNM Classification of the Malignant Tumours. 4th ed. Berlin: Springer, 1987.
Hermanek P, Sobin LH, eds.UICC TNM Classification of the Malignant Tumours. 4th ed, 2nd rev. Berlin: Springer, 1992.
Beahrs OH, Henson DE, Hutter RVP, Kennedy BJ, eds.Manual for Staging of Cancer. American Joint Committee on Cancer. 4th ed. Philadelphia: JB Lippincott, 1992.
Roder JD, Bottcher K, Busch R, et al. Classification of regional lymph node metastasis from gastric carcinoma.Cancer 1998;82:621–31.
Hermanek P, Alterdorf-Hofmann A, Mannsmann U, Dworak O, Wittekind CH, Hohenberger W. Improvements in staging of gastric carcinoma from using the new edition of TNM classification.Eur J Surg Oncol 1998;24:536–41.
Karpeh MS, Leon L, Klimstra D, Brennan MF. Lymph node staging in gastric cancer: is location more important than number?Ann Surg 2000;232:362–71.
Kodera Y, Yamamura Y, Shimizu Y, et al. The number of metastatic lymph nodes: a promising prognostic determinant for gastric carcinoma in the latest edition of the TNM classification.J Am Coll Surg 1998;187:597–603.
Yoo CH, Noh SH, Kim YI, Min JS. Comparison of prognostic significance of nodal staging between old (4th edition) and new (5th edition) UICC TNM classification for gastric carcinoma.World J Surg 1999;23:492–8.
Ichikura T, Tomimatsu S, Uefuji K, et al. Evaluation of the new American Joint Committee on Cancer/International Union Against Cancer classification of lymph node metastasis from gastric carcinoma in comparison with the Japanese classification.Cancer 1999; 86:553–8.
Fujii K, Isozaki H, Okajima K, et al. Clinical evaluation of lymph node metastasis in gastric cancer defined by the fifth edition of the TNM classification in comparison with the Japanese system.Br J Surg 1999;86:685–9.
De Manzoni G, Verlato G, Guglielmi A, et al. Classification of lymph node metastases from carcinoma of the stomach: comparison of the old (1987) and new (1997) TNM systems.World J Surg 1999;23:664–9.
De Almeida JCM, Limbert M, De Almeida JMM. Does the new TNM classification (1997) improve prognostic stratification in gastric cancer submitted to R0 surgery?Eur J Surg Oncol 1999;25:280–3.
Kato M, Saji S, Kawaguchi Y, et al. A comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage in gastric carcinoma.Hepatogastroenterology 1999;46:3281–6.
Hayashi H, Ochiai T, Suzuki T, et al. Superiority of a new UICC-TNM staging system for gastric cancer.Surgery 2000;127:129–35.
Katai H, Yoshinura K, Maruyama K, Sasako M, Sano T. Evaluation of the new International Union Against Cancer TNM staging for gastric carcinoma.Cancer 2000;88:1796–800.
Hermanek P. The superiority of the new International Union Against Cancer and American Joint Committee on Cancer TNM staging of gastric carcinoma.Cancer 2000;88:1763–5.
Okusa T, Nakane Y, Boku T, et al. Quantitative analysis of nodal involvement with respect to survival rate after curative gastrectomy for carcinoma.Surg Gynecol Obstet 1990;170:488–94.
Siewert JR, Bottcher FK, Stein HJ, Roder JD. Relevant prognostic factors in gastric cancer: ten-year results of the German Gastric Cancer Study.Ann Surg 1998;228:449–61.
Yu W, Choi GS, Wang I, Suh IS. Comparison of five systems for staging lymph node metastasis in gastric cancer.Br J Surg 1997; 84:1305–9.
Kodera Y, Yamamura Y, Shimizu Y, et al. Lymph node status assessment for gastric carcinoma: is the number of metastatic lymph nodes really practical as a parameter for N categories in the TNM classification?J Surg Oncol 1998;69:15–20.
Cady B, Ramsden DA, Stein A, Haggitt RC. Gastric cancer: contemporary aspects.Am J Surg 1977;133:423–9.
Haruyama K. Quantitative statistical studies on lymph node metastasis of gastric carcinoma, with reference to its relationship with primary lesion and prognosis.J Jpn Surg Soc 1981;82:612–21.
Kim JP, Jung S-E. Patients with gastric cancer and their prognosis in accordance with number of lymph node metastases.Scand J Gastroenterol 1987;22(Suppl 133):33–5.
Shiu MH, Perrotti M, Brennen MF. Adenocarcinoma of the stomach: a multivariate analysis of clinical, pathologic and treatment factors.Hepatogastroenterology 1989;36:7–12.
Makino M, Moriwaki S, Yonekawa M, Oota M, Kimura O, Kaibara N. Prognostic significance of the number of metastatic lymph nodes in patients with gastric cancer.J Surg Oncol 1991;47:12–6.
Ichikura T, Tomimatsu S, Okusa Y, Uefuji K, Tamakuma S. Comparison of the prognostic significance between the number of metastatic lymph nodes and nodal stage based on their location in patients with gastric cancer.J Clin Oncol 1993;11:1894–900.
Isozaki H, Okajima K, Kawasima Y, Yamada S, Nakata E, Nishimura I. Prognostic value of the number of metastatic lymph nodes in gastric cancer with radical surgery.J Surg Oncol 1993;53:247–51.
Adachi Y, Kamakura T, Mori M, Baba H, Maehara Y, Sugimachi K. Prognostic significance of the number of positive lymph nodes in gastric carcinoma.Br J Surg 1994;81:414–6.
Jatzko GR, Liborg PH, Denk H, Klimpfinger M, Stettner HM. A 10-year experience with Japanese-type radical lymph node dissection for gastric cancer outside Japan.Cancer 1995;76:1302–12.
de Manzoni G, Verlato G, Gugliemi A, Laterza E, Genna M, Cordiano C. Prognostic significance of lymph node dissection in gastric cancer.Br J Surg 1996;83:1604–97.
Kwon SJ, Kim GS. Prognostic significance of lymph node metastasis in advanced carcinoma of the stomach.Br J Surg 1996;38:525–7.
Wu CW, Hsieh MC, Lo SS, Tsay SH, Lui WY, P’eng FK. Relation of number of positive lymph nodes to the prognosis of patients with primary gastric adenocarcinoma.Gut 1996;38:525–7.
Cuschieri A, Weeden S, Fielding J, et al. Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group.Br J Cancer 1999;79:1522–30.
Bonenkamp JJ, Hermans J, Sasako M, van de Velde CJ. Extended lymph-node dissection for gastric cancer. Dutch Gastric Cancer Group.N Engl J Med 1999;340:908–14.
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Inoue, K., Nakane, Y., Iiyama, H. et al. The superiority of ratio-based lymph node staging in gastric carcinoma. Ann Surg Oncol 9, 27–34 (2002). https://doi.org/10.1245/aso.2002.9.1.27
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DOI: https://doi.org/10.1245/aso.2002.9.1.27