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A New pN Staging System Based on Both the Number and Anatomic Location of Metastatic Lymph Nodes in Gastric Cancer

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Our aim was to establish a new pN staging system for gastric cancer based on the number and location of metastatic lymph nodes (MLNs) and to compare it with other systems.

Methods

We retrospectively analyzed the prognostic data of 521 gastric cancer patients who underwent curative resection. Survival analyses were used to establish a pN staging system that considers both the number and location of MLNs and to compare discriminatory ability and monotonicity of gradients (linear trend χ 2 score), homogeneity ability (likelihood ratio test), and prognostic stratification ability (Akaike information criterion) between Japanese Gastric Cancer Association (JGCA) and Union for International Cancer Control (UICC) systems.

Results

Cut-point survival analysis divided pN+ patients into two groups: Nxn1~6 and Nxn≥7. N0, N1, N2, and N3 (the previous classifications) were replaced by N0, N1n1~6, N2n1~6, and N1n≥7 + N2n≥7 + N3n1~6 + N3n≥7, respectively. Compared with two widely used staging systems, the new system had the highest likelihood ratio test [106.06 (new) vs 95.09 (JGCA) vs 94.33 (UICC)] and linear trend χ 2 scores [102.30 (new) vs 89.12 (JGCA) vs 86.97(UICC)] and the lowest Akaike information criterion (AIC) score [2,283.88 (new) vs 2,285.31 (JGCA) vs 2,299.88 (UICC)].

Conclusion

A new pN staging system based on the number and location of MLNs is an efficient prognostic indicator of the survival of patients with gastric cancer following radical surgery.

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Grant Support

This study was supported by research grants from the National Nature Science Foundation of China (No. 30972883)

Conflict of Interest

The authors declare they have no conflict of interests (financial, professional, or personal) which are relevant to the manuscript.

Author Contributions

Dr. Chen Jianhui and Dr. Chen Chuangqi contributed equally to this study, including study concept and design, analysis and interpretation of data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. Dr. He Yulong, Wu KaiMing, and Wu Hui participated in the acquisition of data and statistical analysis. Dr. Cai Shirong supervised the whole study as well as monitored the standard surgical operations. All the authors took part in the surgical operations for gastric cancer.

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Authors and Affiliations

  1. Gastric Cancer Center, Sun Yat-Sen University, Guangzhou, 510080, People’s Republic of China

    Chen Jianhui, Chen Chuangqi, He Yulong, Wu KaiMing, Wu Hui & Cai Shirong

  2. Division of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Zhongshan Road No 2, Guangzhou, 510080, Guangdong, People’s Republic of China

    Chen Jianhui, Chen Chuangqi, He Yulong, Wu KaiMing, Wu Hui & Cai Shirong

  3. Department of Gastrointestinal Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Zhongshan Road No 2, Guangzhou, 510080, Guangdong, People’s Republic of China

    Cai Shirong

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  1. Chen Jianhui
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  2. Chen Chuangqi
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  3. He Yulong
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  4. Wu KaiMing
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  5. Wu Hui
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Correspondence to Cai Shirong.

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Jianhui, C., Chuangqi, C., Yulong, H. et al. A New pN Staging System Based on Both the Number and Anatomic Location of Metastatic Lymph Nodes in Gastric Cancer. J Gastrointest Surg 18, 2080–2088 (2014). https://doi.org/10.1007/s11605-014-2663-5

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  • DOI: https://doi.org/10.1007/s11605-014-2663-5

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