Gastric Cancer

, Volume 11, Issue 2, pp 111–118 | Cite as

Validation of staging systems for gastric cancer

  • Keishi Yamashita
  • Shinichi Sakuramoto
  • Shiroh Kikuchi
  • Natsuya Katada
  • Nobuyuki Kobayashi
  • Masahiko Watanabe
Original Article

Abstract

Background

The two major staging systems for gastric cancer, the Japanese classification of gastric cancer (JCGC) and the International Union Against Cancer (UICC) TNM system, are periodically revised as a consequence of critical validation studies in light of newly accumulated clinical data. This study aimed to validate and improve upon the current versions for a better prognostic stratification of gastric cancer.

Methods

One thousand and ten gastric cancer patients who underwent tumor resection were enrolled at the Kitasato University Hospital for staging validation. According to the JCGC stage, the patients consisted of stage IA (n = 453), IB (n = 185), II (n = 119), IIIA (n = 75), IIIB (n = 51), and IV (n = 127).

Results

Regarding consistency between the JCGC and the UICC system, the results were: for patients in stage IA (100%), IB (98%), II (84%), IIIA (51%), IIIB (24%), and IV (64%). The JCGC system was superior to the UICC system for the prognostic stratification of stage IIIA, IIIB, and IV cancers; we therefore used the JCGC system for prognostic validation according to depth of invasion in cancers of the same stage. Stage II and IIIA cancers were heterogeneous for prognosis according to depth of invasion, and the outstanding difference was found between the muscularis propria (MP) and subserosa (SS), which are both classified as pT2 in the JCGC system. MP cancer represented an earlier property of gastric cancer rather than an advanced one. A proposed novel staging system adjusted for this heterogeneity provided a clearer stratification of prognosis with a homogeneous prognostic distribution within each stage.

Conclusion

Our findings revealed that invasion into the MP has an earlier propensity than expected, and a novel staging system taking this into account may provide a better stratification of prognosis than the current systems.

Key words

Gastric Cancer Staging Validation MP 

References

  1. 1.
    Desai AM, Pareek M, Nightingale PG, Fielding JW. Improving outcomes in gastric cancer over 20 years. Gastric Cancer 2004;7:196–203.PubMedCrossRefGoogle Scholar
  2. 2.
    Crew KD. Epidemiology of gastric cancer. World J Surg 2006;12:354–362.Google Scholar
  3. 3.
    Yokota T, Ishiyama S, Saito T, Teshima S, Shimotsuma M, Yamaguchi H. Treatment strategy of limited surgery in the treatment guidelines for gastric cancer in Japan. Lancet Oncol 2003;4:423–428.PubMedCrossRefGoogle Scholar
  4. 4.
    Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma — 2nd English edition —. Gastric Cancer 1998;1:10–24.PubMedCrossRefGoogle Scholar
  5. 5.
    Sobin LH, Witteking Ch, editors. International Union Against Cancer TNM classification of malignant tumours. 6th ed. New York: Wiley-Liss; 2002.Google Scholar
  6. 6.
    Ichikura T, Tomimatsu S, Uefuji K, Kimura M, Uchida T, Morita D, 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;86:553–558.PubMedCrossRefGoogle Scholar
  7. 7.
    Fujii K, Isozaki H, Okajima K, Nomura E, Niki M, Sako S, 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;86:685–689.PubMedCrossRefGoogle Scholar
  8. 8.
    Hayashi H, Ochiai T, Suzuki T, Shimada H, Hori S, Takeda A, et al. Superiority of a new UICC-TNM staging system for gastric carcinoma. Surgery 2000;127:129–135.PubMedCrossRefGoogle Scholar
  9. 9.
    Nio Y, Yamasawa K, Yamaguchi K, Itakura M, Omori H, Koike M, et al. Problems in the N-classification of the new 1997 UICC TNM stage classification for gastric cancer: an analyisis of over 10 years’ outcome of Japanese patients. Anticancer Res 2003;23:697–705.PubMedGoogle Scholar
  10. 10.
    Ikeguchi M, Murakami D, Kanaji S, Ohro S, Maeta Y, Yamaguchi K, et al. Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems. ANZ J Surg 2004;74:852–854.PubMedCrossRefGoogle Scholar
  11. 11.
    Japanese Gastric Cancer Association Registration Committee, Maruyama K, Kaminishi M, Hayashi K, Isobe Y, Honda I, et al. Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer 2006;9:51–66.PubMedCrossRefGoogle Scholar
  12. 12.
    Yamashita K, Sakuramoto S, Kikuchi S, Katada N, Kobayashi N, Watanabe M. Surgical resection of stage IV gastric cancer and prognosis. Anticancer Res 2007;27:4381–4386.PubMedGoogle Scholar
  13. 13.
    Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457–4581.CrossRefGoogle Scholar
  14. 14.
    Cox DR. Regression models and life-tables. J R Stat Soc (B) 1972;34:187–220.Google Scholar
  15. 15.
    Kikuchi S, Sato M, Katada N, Sakuramoto S, Kobayashi N, Shimao H, et al. Surgical outcome of node-positive early gastric cancer with particular reference to nodal status. Anticancer Res 2000;20:3695–700.PubMedGoogle Scholar
  16. 16.
    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.PubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2008

Authors and Affiliations

  • Keishi Yamashita
    • 1
  • Shinichi Sakuramoto
    • 1
  • Shiroh Kikuchi
    • 1
  • Natsuya Katada
    • 1
  • Nobuyuki Kobayashi
    • 1
  • Masahiko Watanabe
    • 1
  1. 1.Department of SurgeryKitasato University HospitalKanagawaJapan

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