Evaluation of the 7th UICC TNM Staging System of Gastric Cancer

Abstract

Since January of 2010, the seventh edition of UICC tumor node metastasis (TNM) Classification, which has recently been revised, has been applied to almost all cases of malignant tumors. Compared to previous editions, the merits and demerits of the current revisions were analyzed. Many revisions have been made for criteria for the classification of lymph nodes. In particular, all the cases in whom the number of lymph nodes is more than 7 were classified as N3 without being differentiated. Therefore, the coverage of the N3 was broad. Owing to this, there was no consistency in predicting the prognosis of the N3 group. By determining the positive cases to a distant metastasis as TNM stage IV, the discrepancy in the TNM stage IV compared to the sixth edition was resolved. In regard to the classification system for an esophagogastric (EG) junction carcinoma, it was declared that cases of an invasion to the EG junction should follow the classification system for esophageal cancer. A review of clinical cases reported from Asian patients suggests that it would be more appropriate to follow the previous editions of the classification system for gastric cancer. In addition, in the classification of the TNM stages in the overall cases, the discrepancy in the prognosis between the different stages and the consistency in the prognosis between the same TNM stages were achieved to a lesser extent as compared to that previously. Accordingly, further revisions are needed to develop a purposive classification method where the prognosis can be predicted specifically to each variable and the mode of the overall classification can be simplified.

Identifying therapeutic targets in gastric cancer: the current status and future direction

“…Clinically, gastric cancer can be divided into four stages [13], which are closely associated with patient outcomes and widely used for patient treatment options. Stage I disease has tumors mostly within the stomach mucosa (IA has no lymph node spread whereas IB has one to two lymph node spread in stomach).…”

Surgical Treatment of Gastric Adenocarcinoma: Total vs. Subtotal Gastrectomy. A Single Centre Experience

“…Some revisions have been made for the classification of lymph nodes (12). Our study is based on data between 2007 and 2011, so TNM revision may influence results of our study by modification in N category.…”

Impact of using a lymph node revealing solution in surgical specimens for pathological staging of gastric cancer

“…After using LRS, the number of 16 LNs was achieved in one case, and 19 LNs in the other, enabling a more secure staging, despite the fact that the (15) 31.6 pN classification did not change. Several studies described in the literature concluded that there must be 16 or more LNs analyzed for pN0 staging to be achieved (1,16,21,27,31) . Son et al (31) analyzed the survival rate of 10,010 patients and concluded that when 15 or less LNs are examined and findings show no metastases (classified pN0 by TNM system), it is not possible to appropriately predict the survival of patients undergoing curative gastrectomy.…”