Evaluation of the seventh AJCC TNM staging system for gastric cancer: a meta-analysis of cohort studies

Abstract

The AJCC seventh edition TNM classification for gastric cancer was released in 2010 and included major revision. Large-volume gastric cancer centers have evaluated the prognostic significance of the new system and obtained paradoxical results. The authors performed a meta-analysis of these studies to evaluate the new classification. Fifteen eligible studies with 38,972 patients were included in the analysis. Hazard ratios (HRs) and associated 95 % confidence intervals were extracted from identified studies. The primary outcome was overall survival. The HRs for the seventh edition T classification and N classification were found to increase steadily and reasonably. The cumulative survival rates of the seventh edition subgroups of T classifications demonstrated obvious differences; meanwhile, the differences between subgroups of N classifications including N3a and N3b categories were also significant. The 5-year survival rates according to the seventh edition TNM staging system were 94.71 % (stage IA), 88.72 % (stage IB), 80.45 % (stage IIA), 67.24 % (stage IIB), 53.68 % (stage IIIA), 37.56 % (stage IIIB), and 21.26 % (stage IIIC), respectively. The results of this study indicate that the seventh edition of the TNM classification was considered valid, although further evaluation was needed for N3a and N3b categories.

FGF7/FGFR2 signal promotes invasion and migration in human gastric cancer through upregulation of thrombospondin-1

“…Especially, FGFR2 was highly expressed in T4 or stage III and IV patients, and its increased expression tended to correlate with invasion and migration. The 5-year survival rates for stage I and II patients exceeded 60%, while the rates for stage III and IV patients rarely exceeded 50% (33). Despite many advances in diagnosis and treatment of this disease, the prognosis for gastric cancer remains poor, especially in more advanced stages.…”

Factors associated with early recurrence after curative surgery for gastric cancer

“…None of these patients had distant or peritoneal metastasis at the time of resection, as shown by chest X-ray or chest computed tomography (CT) scan and abdominal pelvic CT scan before surgery. Tumor (T) and node (N) status was reclassified according to the 7 th edition of the American Joint Committee on Cancer (AJCC) tumor-nodemetastasis (TNM) classification for carcinoma of the stomach [15,16] .…”

Validation of the 7th AJCC/UICC staging system for gastric cancer and a proposal for a new TNM system based on a prognostic score: a retrospective multicenter study

“…These changes included reclassification of T2a and T2b to T2 and T3, respectively; division of the previous N1 stage (up to 6 metastatic regional lymph nodes) into N1 (1 or 2 metastatic regional lymph nodes) and N2 (3 to 6 metastatic regional lymph nodes); and reclassification of the previous N2 (7 to 15 metastatic regional lymph nodes) and N3 stages (more than 15 metastatic regional lymph nodes) to N3a (7 to 15 metastatic regional lymph nodes) and N3b (more than 15 metastatic regional lymph nodes) [234]. Although the 7th AJCC/UICC staging system for gastric cancer has been reported to be more accurate or valid by some authors [3567], the system is not without controversy. One of the most common controversies is classification of the N category, such that the discriminative power of the N category in the 7th UICC/AJCC staging system has been decreased relative to that of the 6th AJCC/UICC staging system [89].…”