Validity and Necessity of Sub-classification of N3 in the 7^thUICC TNM Stage of Gastric Cancer

Abstract

Background: The 7 th TNM staging is the first authoritative standard for evaluation of effectiveness of treatment of gastric cancer worldwide. However, revision of pN classification within TNM needs to be discussed. In particular, the N3 sub-stage is becoming more conspicuous. Methods: Clinical data of 302 pN3M0 stage gastric cancer patients who received radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital from January 2001 to May 2006 were retrospectively analyzed. Results: Location of tumor, depth of invasion, extranodal metastasis, gastric resection, combined organs resection, lymph node metastasis, rate of lymph node metastasis, negative lymph nodes count were important prognostic factors of pN3M0 stage gastric cancers. TNM stage was also associated with prognosis. Patients at T2N3M0 stage had a better prognosis than other sub-classification. T3N3M0 and T4aN3aM0 patients had equal prognosis which followed the T2N3M0. T4aN3bM0 and T4bN3aM0 had lower survival rate than the formers. T4bN3bM0 had worst prognosis. In multivariate analysis, TNM stage group and rate of lymph node metastasis were independent prognostic factors. Conclusions: The sub-stage of N3 may be useful for more accurate prediction of prognosis; it should therefore be applied in the TNM stage system.

Aberrant Expression of the Autocrine Motility Factor Receptor Correlates with Poor Prognosis and Promotes Metastasis in Gastric Carcinoma

“…Multifactorial Cox regression analysis was used to avoid confounder effects (Table 4). To adjust the risk ratio (RR), factors including histological grade, (Peng et al, 2013;Li et al, 2013;Graziosi et al, 2013), supporting the accuracy of our study. Together, these data revealed the expression of AMFR was a risk factor indicating poor prognosis in GC patients following surgical resection.…”

Tumour deposits are a significant prognostic factor in gastric cancer – a systematic review and meta‐analysis

“…Duplicates and studies that did not meet the inclusion criteria were excluded (Figure ). Three studies had overlapping patient data, thus we included the study with the largest patient group . We excluded studies with extranodal extension of lymph node metastasis and a study with junction cancers because it included patients with cancer in the gastro‐oesophageal junction.…”

The IGCA staging system is more accurate than AJCC7 system in stratifying survival of patients with gastric cancer in stage III

“…As a matter of fact, the 5-year survival rate of T3N3b was even poorer than stage IIIC disease. Whether this subgroup, together with T4N3b [ 6 ], should be considered as stage IV diseases needs further assessment [ 10 – 12 ].…”