Tumor–ratio–metastasis staging system as an alternative to the 7th edition UICC TNM system in gastric cancer after D2 resection—results of a single-institution study of 1343 Chinese patients

Wang, W.; Xu, Da; Li, Y. F.; Guan, Yuanxiang; Sun, Xiaowei; Chen, Y. B.; Kesari, R.; Huang, Chun Fa; Li, W.; Zhan, You Qing; Zhou, Zhiwei

doi:10.1093/annonc/mdq716

Cited by 84 publications

(93 citation statements)

References 29 publications

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“…To evaluate the rN staging system, some previous reports excluded patients with fewer than 16 LNs retrieved [16,20,22]; some researchers preferred the patients treated by limited lymphadenectomy, [9,10,18,23]; and some centers evaluated the rN system as an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy, or in both [15 and B15 LNs examined [17,19,24,25], as we did in our report. All the reports indicated that the rN staging system has superiority in prognosis assessment compared with the traditional AJCC pN system.…”

Section: Discussionmentioning

confidence: 87%

“…However, there is much controversy regarding the most appropriate cutoff ratio because the ratios differ among investigators. The following cutoff values have been proposed: 0, 0.20, 0.50 [10,24], 0, 0.30, 0.60 [15,25], 0, 0.10, 0.25 [9,16,20], 0, 0.30, 0.70 [17], 0, 0.015, 0.40 [23], 0, 0.10, 0.25 [19], 0, 0.25, 0.50 [18], and 0, 0.10, 0.40 [22]. The cutoff values showed great variety in different countries, even in different centers in the same country.…”

Section: Discussionmentioning

confidence: 99%

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The evaluation of metastatic lymph node ratio staging system in gastric cancer

et al. 2012

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Background To evaluate the prognostic value and staging accuracy of the metastatic lymph node ratio (rN) staging system for gastric cancer. Methods A total of 1,075 patients with gastric cancer who underwent curative surgery between 2000 and 2009 at our institute were analyzed. Lymph node status was assigned according to the American Joint Committee on Cancer (AJCC) pN system and rN system. Patients with [15 (group 1, n = 691) and B15 lymph nodes (group 2, n = 384) retrieved were analyzed separately. Results The rN staging system was generated using 0.2 and 0.5 as the cutoff values of lymph node ratio and then compared with AJCC pN stages. A linear regression model revealed that the number of retrieved lymph nodes was related to the number of metastatic lymph nodes, but not with rN. After a median follow-up of 47.66 months, the 5-year survival rates of N0, N1, N2, and N3 patients of group 1 were significantly better than group 2, whereas the differences were not obvious in the rN classification. Conclusions The rN category is a better prognostic tool than the AJCC pN category for gastric cancer patients after curative surgery regardless of the number of lymph node examined.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

The evaluation of metastatic lymph node ratio staging system in gastric cancer

et al. 2012

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“…A study conducted in China proved a better prognostic stratification for the new actualized version [1]. Another study from Korea showed similar results for the new TNM system, proving a more detailed prognostic assessment, especially between T2 and T3 and N1 and N2 tumors [2].…”

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confidence: 72%

Gastric Cancer: Clinical Aspects, Epidemiology and Molecular Background

et al. 2011

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In 2010, the WHO introduced the seventh edition of the tumor node metastasis (TNM) classification that provides a more detailed classification for both local tumor invasion (T) and lymph node involvement (N) compared with the previous version. The T and N categories of tumors located in the stomach have been further modified with the intention to ensure a better correlation to the prognostic outcome. For the classification of a pN0, the number of lymph nodes has been adjusted to 16.The description of tumors with origin in the esophagus has been simplified and includes tumors of the esophagogastric junction as well as gastric tumors extending to the proximal 5 cm of the stomach. Major changes are further the subclassification of the categories T1 and T4 and the new N categorization now considering the number of lymph nodes involved within tree categories. Furthermore, positive lymph nodes in the region of the celiac trunc are considered as regional in case of esophageal cancers.The validity of the new classification system in its prognostic efficacy was compared to the previous edition. A study conducted in China proved a better prognostic stratification for the new actualized version [1]. Another study from Korea showed similar results for the new TNM system, proving a more detailed prognostic assessment, especially between T2 and T3 and N1 and N2 tumors [2]. The advantage of the new (7th) edition was mainly confirmed for the prognostic value of accurate lymph node assessment [3].Concerning the classification of early gastric cancer (GC) in the new system, a study from Italy confirmed the usefulness of the new classification for metastatic lymph nodes as a prognostic tool in case of early GC. AbstractThe validity and usefulness of the 7th edition of the UICC tumor node metastasis classification in the context of clinical management of gastric cancer are discussed. The most relevant new agent in gastric cancer therapy is trastuzumab for HER2-positive gastric carcinomas. This marks the success of continuous effort of translational research. Trastuzumab, initially applied in palliative settings, is currently being evaluated also in neoadjuvant treatment regimens. Several new meta-analyses support the carcinogenic effect of high salt intake and smoking in the context of Helicobacter pylori infection. Further data have become available on the efficacy of protective agents, acetyl salicylic acid ⁄ nonsteroidal anti-inflammatory drugs, and antioxidants. In search for a successful prevention strategy, the focus is on the identification of individuals at high risk who demand screening (testing) and surveillance. Serological assessment of gastric mucosal abnormalities with increased risk for gastric cancer development is extensively studied, and new data are presented from Asia as well as from Europe. New high-throughput techniques combined with bioinformatic vector analysis open the gate to the identification of new potential diagnostic and therapeutic targets. Furthermore, these approaches allow us to elucidate the int...

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“…Previous studies have demonstrated that the effects of LNR staging is superior to that of pN staging in predicting prognosis of patients for many cancer sites: colon (Chen et al, 2011), gastric (Wang et al, 2011;Yu et al, 2011), pancreas (Pawlik et al, 2007;Keck et al, 2012), esophagus (Greenstein et al, 2008), corpus uteri (Chan et al, 2007) and bladder (Herr, 2003).…”

Section: Discussionmentioning

confidence: 99%