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Incorporation of N0 Stage with Insufficient Numbers of Lymph Nodes into N1 Stage in the Seventh Edition of the TNM Classification Improves Prediction of Prognosis in Gastric Cancer: Results of a Single-Institution Study of 1258 Chinese Patients

  • Gastrointestinal Oncology
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This study examined the prognosis of the “node-negative with eLNs ≤ 15” designation and the additional value of incorporating it into the pN1 designation in the seventh edition of the N classification.


From January 2000 to September 2010, a total of 1258 gastric cancer patients (patients with eLNs > 15 or node-negative with eLNs ≤ 15) undergoing radical gastric resection were enrolled in this study. We incorporated node-negative patients with eLNs ≤ 15 into pN1 and compared this designation with the current 7th edition UICC N stage for 3, 5-year overall survival by univariate and multivariate analysis. Homogeneity, discriminatory ability, and monotonicity of gradients in the hypothetical N stage and the UICC N stage were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations.


Node-negative patients with eLNs ≤ 15 had worse survival compared with those with eLNs > 15. In univariate and multivariate analyses, the hypothetical N stage showed superiority to the 7th edition pN staging. The hypothetical staging system had higher linear trend and likelihood ratio χ 2 scores and smaller AIC values compared with those for the TNM system, which represented the optimum prognostic stratification.


Node-negative patients with eLNs ≤ 15 can be considered to be incorporated into the pN1 stage in the 7th edition of the TNM classification.

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This work was supported by the National Natural Science Foundation of China (81172080 and 81201773), the Research Fund for the Doctoral Program of Higher Education of China by the Ministry of Education (20100171110084 and 20120171120114), and the Science and Technology Project of Guangdong Province (2011B031800181). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.


The authors have declared no conflicts of interest related to this work.

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Correspondence to Zhiwei Zhou MD.

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Bofei Li, Yuanfang Li and Wei Wang have contributed equally to this work.

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Supplementary material 2 (TIFF 6865 kb) Supplementary figure 1. Flowchart of study design. SYSUCC: Sun Yat-senUniversity Cancer Center; MLNs: Metastatic lymph nodes; eLNs: Examined lymphnodes.

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Li, B., Li, Y., Wang, W. et al. Incorporation of N0 Stage with Insufficient Numbers of Lymph Nodes into N1 Stage in the Seventh Edition of the TNM Classification Improves Prediction of Prognosis in Gastric Cancer: Results of a Single-Institution Study of 1258 Chinese Patients. Ann Surg Oncol 23, 142–148 (2016).

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