Comparison of five systems for staging lymph node metastasis in gastric cancer

Yu, Wansik; Choi, Gyu Seog; Whang, Ilwoo; Suh, In Soo

doi:10.1002/bjs.1800840931

Cited by 41 publications

(22 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Authors from Korea also proposed the number of involved nodes (0, 1-3 and 4) (Kim et al, 1995). Others have proposed to use metastatic rate (Kodera et al, 1997;Yu et al, 1997). We also found that the new TNM classification based on the number of positive nodes gives better prognostic information than the old TNM classification based on location of positive nodes.…”

Section: Discussionmentioning

confidence: 65%

See 1 more Smart Citation

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

et al. 2001

View full text Add to dashboard Cite

SummaryThe main change in the 5th edition (1997) of the TNM classification for gastric cancer compared to the 4th edition (1987) is the use of the number of involved nodes instead of the location of positive nodes. As a result stage grouping is also altered. A second change is the requirement for the examination of at least 15 nodes to justify the N0 status. Patients with fewer examined negative nodes are unclassifiable (Nx). Data were retrieved from a randomized trial database comparing D1 and D2 dissection and 633 curatively operated patients were included. According to the criteria of the 5th edition, 39% of the node-positive patients had another N stage compared to the 4th: 21% had a lower and 18% had a higher stage. 5-year survival rates according to the 4th edition N0, N1 and N2 groups were respectively 72%, 34% and 27%. According to the 5th edition these percentages were for the N0, N1, N2, N3 and Nx groups respectively 75%, 38%, 19%, 8% and 65%. The former 1987 N1 and N2 group were significantly split into three new N 1997 groups (P = 0.006, respectively P < 0.0005). The Cox's regression analysis showed the N 1997 classification to be the most important prognostic variable, with a higher prognostic value than N 1987. In addition, the new TNM stage was also a better prognosticator. The requirement for examining at least 15 nodes, however, could not be fulfilled in 38% of all nodenegative patients and we found that a minimum of 5 consecutive negative lymph nodes is a reliable number for staging purposes. We conclude that the 5th edition of the TNM classification provides a better estimation of prognosis, however, examination of at least 15 negative regional lymph nodes is too high a threshold and 5 gives similar prognostic value. 64-71 © 2001 Cancer Research Campaign doi: 10.1054/ bjoc.2000.1548, available online at http://www.idealibrary.com on http://www.bjcancer.com abdominal washing, 35 due to resection-line involvement and 3 patients due to positive cytology as well as positive margins. In 5 of the remaining 639 R0 patients, no primary tumour could be found and in one patient the T-stage could not be determined due to inadequate specimen handling. The present report will therefore be based on 633 patients, including 44 patients who died in the post-operative phase (in-hospital death or within 30 days after surgery), since the postoperative mortality was different between the D1 and D2 group (15 versus 29 patients). Survival time was calculated from the date of surgery until death or last follow-up alive. The range in follow-up time of patients still alive was 6.0 to 10.2 years, with a median follow-up of 7.9 years. ClassificationsIn (Table 2). As said before, we had to make additional to the official 1997 TNM definitions, a Nx category and consequently an 'unclassifiable' TNM category for the node-negative patients with <15 lymph nodes examined (TNMx). StatisticsThe χ 2 test was applied to assess differences in the distribution of patients among groups. The Mann-Whitney test was used for comparis...

show abstract

Section: Discussionmentioning

confidence: 65%

“…the number of involved nodes (Wu et al, 1996). N classifications separately for T1, T2 and T3 (Ichikura et al, 1993) for nodal metastatic rate <50% and ≥50% (Kodera et al, 1997) or for ≤25% and >25% (Yu et al, 1997) have also been proposed.…”

mentioning

confidence: 99%

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

et al. 2001

View full text Add to dashboard Cite

show abstract

“…Furthermore, another incidental finding that has not yet been commented on is the relation between survival and the ratio of involved and uninvolved nodes. A few studies have investigated ratiobased staging in gastric cancer (25,26). Fig.…”

Section: ------------------------------------------------------------mentioning

confidence: 99%

Effect of the number of uninvolved nodes on survival in early breast cancer

Vinh‐Hung¹,

Cserni²,

Burzykowski³

et al. 2003

Oncol Rep

View full text Add to dashboard Cite

Abstract.A high number of uninvolved axillary nodes was found by some authors to be associated with poor survival in node-negative breast cancer. We searched for confirmation and extend the investigation to node-positive cases, using population data from the SEER Program. Patients selected were women aged 40-69 years, diagnosed 1988-1997, T1-T2 breast cancer, undergoing axillary dissection with 4-35 nodes examined. Survivals were estimated by the product-limit method and were computed on pooled data. Results in nodenegative patients (n=37,519) showed a 5-year overall survival from 92% (95% confidence interval: 88-95%) with 4 uninvolved nodes, to 93% (87-98%) with 34 uninvolved nodes. In node-positive patients (n=16,978), the 5-year survival increased from 50% (44-56%) with 0 uninvolved nodes, to 91% (82-100%) with 30 uninvolved nodes. Survival graphs indicated an improvement or a plateau with higher number of uninvolved nodes. The graphs also suggested that the ratio of involved and uninvolved nodes might be correlated with survival. We conclude that there was no evidence of poor outcome associated with a high number of uninvolved nodes. The incidental finding that ratio-based characterization of node involvement might be a prognostic factor will be further investigated. IntroductionTumor draining lymph nodes can undergo hyperplasia, resulting in increases in the number and size of detectable lymph nodes. A high number of tumor free axillary lymph nodes might thus represent the effect of lymphangiogenic and lymph node development factors playing a role in tumor metastasis (1). In support of that hypothesis, Camp et al reported that axillary dissection yielding more than 20 nodes in node-negative breast cancer was associated with a poor survival (1) when compared with node-negative breast cancer patients having less than 20 nodes examined.The Surveillance, Epidemiology, and End Results (SEER) provides detailed data on nodal extent for cases diagnosed since 1988 (2). The objective of the present study is to examine the pattern of survival, whether or not there is supportive evidence in the SEER registries data that high numbers of uninvolved nodes (nneg) are indicators of poor outcome.If lymphogenic factors are involved in node-negative (N0) breast cancer, then it should be expected that these factors are also involved in node-positive (N + ) cases. Therefore, consistency requires that the role of nneg should be examined in both N0 and N + cases, taking into account the number of positive nodes (npos).Outline of this study and results of a multivariate analysis by proportional hazard models have been reported previously (3). The mortality hazard ratio associated with the number of uninvolved nodes was 0.990 (95% confidence interval: 0.983-0.996) in N0, and 0.970 (0.963-0.976) in N + , i.e. 1% risk reduction and 3% risk reduction per uninvolved node, respectively. These results argued against the role of uninvolved nodes as indicators of poor prognosis. The present report will focus on the visual display of data. W...

show abstract

“…Este efecto de la migración del estadio se conoce como fenómeno de Will Rogers 8 . Un elemento importante que corrige estos factores, que se considera desde hace algunos años, es el índice ganglionar, el cual corresponde al cociente entre los ganglios comprometidos por cáncer y el total de ganglios disecados de la PO 9 . La estimación del compromiso ganglionar por cáncer de la PO por el cirujano es errática, tanto al evaluar la cantidad de ganglios comprometidos por cáncer como el compromiso según los grupos ganglionares defi nidos por la clasifi cación japonesa.…”

Section: Discussionunclassified

Valoración del análisis de la pieza operatoria en el cáncer gástrico por el cirujano

Ceroni

et al. 2011

Rev Chil Cir

View full text Add to dashboard Cite

Concordance between the surgical piece observation by the surgeon and fi nal pathological report for gastric cancer Background: The systematic dissection of the surgical piece, performed by the surgeon during surgical treatment of gastric cancer, gives information about borders and lymph node involvement. Aim: To determine the concordance between the fi ndings of the surgeon during initial dissection and the fi nal pathological report. Material and Methods: Prospective study of 48 patients aged 64 ± 10 years (74% males) subjected to curative surgery for gastric cancer. Patients were staged according to 2010 TNM classifi cation. Stomach size from the lesser curvature, oral and caudal limits, macroscopic aspect, tumor diameter and lymph node involvement were determined by the surgeon observing the surgical piece. The concordance of this observation with the fi nal pathological report was assessed. Results: Fifty nine percent of patients were subjected to a total gastrectomy and there was a mean of 30 lymph nodes excised. There was a good concordance between surgeon observation and fi nal pathological report for tumor depth (Kappa = 0.64), macroscopic aspect (Kappa = 0.69) and tumor size (Lin = 0.84). There was a bad concordance for lymph node involvement (Kappa = 0.21). The percentage of retraction of lesser curvature length was 24%, 30% for oral and 22% for caudal limits. Conclusions: There is a good concordance between surgeon observation and pathological report for macroscopic aspect, tumor size and depth but the concordance for lymph node involvement is bad.

show abstract

Comparison of five systems for staging lymph node metastasis in gastric cancer

Cited by 41 publications

References 10 publications

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

Evaluation of the 5th edition of the TNM classification for gastric cancer: improved prognostic value

Effect of the number of uninvolved nodes on survival in early breast cancer

Valoración del análisis de la pieza operatoria en el cáncer gástrico por el cirujano

Contact Info

Product

Resources

About