Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 12/2014

01-12-2014 | Original Article

A New pN Staging System Based on Both the Number and Anatomic Location of Metastatic Lymph Nodes in Gastric Cancer

Authors: Chen Jianhui, Chen Chuangqi, He Yulong, Wu KaiMing, Wu Hui, Cai Shirong

Published in: Journal of Gastrointestinal Surgery | Issue 12/2014

Login to get access

Abstract

Background

Our aim was to establish a new pN staging system for gastric cancer based on the number and location of metastatic lymph nodes (MLNs) and to compare it with other systems.

Methods

We retrospectively analyzed the prognostic data of 521 gastric cancer patients who underwent curative resection. Survival analyses were used to establish a pN staging system that considers both the number and location of MLNs and to compare discriminatory ability and monotonicity of gradients (linear trend χ 2 score), homogeneity ability (likelihood ratio test), and prognostic stratification ability (Akaike information criterion) between Japanese Gastric Cancer Association (JGCA) and Union for International Cancer Control (UICC) systems.

Results

Cut-point survival analysis divided pN+ patients into two groups: Nxn1~6 and Nxn≥7. N0, N1, N2, and N3 (the previous classifications) were replaced by N0, N1n1~6, N2n1~6, and N1n≥7 + N2n≥7 + N3n1~6 + N3n≥7, respectively. Compared with two widely used staging systems, the new system had the highest likelihood ratio test [106.06 (new) vs 95.09 (JGCA) vs 94.33 (UICC)] and linear trend χ 2 scores [102.30 (new) vs 89.12 (JGCA) vs 86.97(UICC)] and the lowest Akaike information criterion (AIC) score [2,283.88 (new) vs 2,285.31 (JGCA) vs 2,299.88 (UICC)].

Conclusion

A new pN staging system based on the number and location of MLNs is an efficient prognostic indicator of the survival of patients with gastric cancer following radical surgery.
Literature
1.
Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol. 2006; 24(14):2137–50.PubMedCrossRef
2.
3.
Wang YC, Wei LJ, Liu JT, et al. Comparison of Cancer Incidence between China and the USA. Cancer Biol Med. 2012;9(2):128–132.PubMedCentralPubMed
4.
5.
Cambruzzi E, Azeredo AM, Kronhart A et al. The presence of metastases in regional lymph nodes is associated with tumor size and depth of invasion in sporadic gastric adenocarcinoma. Arq Bras Cir Dig. 2014;27(1):18–21.PubMedCrossRef
6.
Fleming ID, Cooper JS, Henderson DE. AJCC cancer staging manual, 5th edition. New York: Springer, 1997.
7.
Edge SB, Byrd DR, Compton CC, et al. American Joint Committee on Cancer (AJCC) cancer staging manual. 7th ed. Chicago: Springer, 2010.
8.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011. 14(2):113–123.CrossRef
9.
Fielding LP, Fenoglio-Preiser CM, Freedman LS. The future of prognostic factors in outcome prediction for patients with cancer. Cancer. 1992;70(9):2367–77.PubMedCrossRef
10.
Japanese Gastric Cancer Association. Japanese classification of Gastric Cancer-14th edition (2010) -. KANEHARA & CO., LTD; Tokyo (Japanese)
11.
Kunisaki C, Shimada H, Nomura M, et al. Comparative evaluation of gastric carcinoma staging: Japanese classification versus new american joint committee on cancer/international union against cancer classification. Ann Surg Oncol. 2004;11(2):203–6.PubMedCrossRef
12.
Hayashi H, Ochiai T, Suzuki T, Shimada H, Hori S, Takeda A, et al. Superiority of a new UICC-TNM staging system for gastric carcinoma. Surgery. 2000;127(2):129–35.PubMedCrossRef
13.
Hidaka H, Eto T, Maehara N, Jimi S, Hotokezaka M, Chijiiwa K. Comparative effect of lymph node metastasis classified by the anatomical site or by the number of nodes involved on prognosis of patients with gastric cancer. Hepatogastroenterology. 2008;55(88):2269–72.PubMed
14.
Ichikura T, Tomimatsu S, Uefuji K, Kimura M, Uchida T, Morita D, et al. Evaluation of the New American Joint Committee on Cancer/International Union against cancer classification of lymph node metastasis from gastric carcinoma in comparison with the Japanese classification. Cancer. 1999;86(4):553–8.PubMedCrossRef
15.
Celen O, Yildirim E, Gülben K, Berberoğlu U. Prediction of survival in gastric carcinoma related to lymph node grading by the new American Joint Committee on Cancer/Union International Contre le Cancer System or the Japanese system. Eur J Surg Suppl. 2003;(588):33–9.PubMed
16.
Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 1995; 345(8952):745–8.PubMedCrossRef
17.
Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: Preliminary results of the MRC randomized controlled surgical trial. Lancet. 1996;347(9007):995–9.PubMedCrossRef
18.
Feinstein AR, Sosin DM, Wells CK. The Will Rogers phenomenon. Stage migration and new diagnostic techniques as a source of misleading statistics for survival in cancer. N Engl J Med. 1985;312(25):1604–8.PubMedCrossRef
19.
Ohno S, Tachibana M, Shibakita M, Dhar DK, Yoshimura H, Kinugasa S, et al. Prognostic significance of Fas and Fas ligand system-associated apoptosis in gastric cancer. Ann Surg Oncol. 2000;7(10):750–7.PubMedCrossRef
20.
Yamashita K, Sakuramoto S, Kikuchi S, Katada N, Kobayashi N, Watanabe M. Validation of staging systems for gastric cancer. Gastric Cancer. 2008;11(2):111–8.PubMedCrossRef
21.
Ikeguchi M, Murakami D, Kanaji S, Ohro S, Maeta Y, Yamaguchi K, et al. Lymph node metastasis of gastric cancer: comparison of Union International Contra Cancer and Japanese systems. ANZ J Surg. 2004;74(10):852–4.PubMedCrossRef
22.
Tong JH, Sun Z, Zhu Z, et al. Prognostic significance of lymph node station 7 for patients with gastric cancers underwent radical surgery. J Surg Oncol. 2012. 105(8):805–812.PubMedCrossRef
23.
Kim JP, Yang HK, Oh ST. Is the new UICC staging system of gastric cancer reasonable? (Comparison of 5-year survival rate of gastric cancer by old and new UICC stage classification). Surg Oncol. 1992;1(3):209–13.PubMedCrossRef
24.
Li F, Zhang R, Liang H, et al. The pattern of lymph node metastasis and the suitability of 7th UICC N stage in predicting prognosis of remnant gastric cancer. J Cancer Res Clin Oncol. 2012. 138(1):111–117.PubMedCrossRef
25.
Deng J, Liang H, Sun D, et al. Suitability of 7th UICC N stage for predicting the overall survival of gastric cancer patients after curative resection in China. Ann Surg Oncol. 2010. 17(5):1259–1266.PubMedCrossRef
26.
Deng JY, Liang H, Sun D, et al. The most appropriate category of metastatic lymph nodes to evaluate overall survival of gastric cancer following curative resection. J Surg Oncol. 2008;98(5):343–8.PubMedCrossRef
27.
Ueno S, Tanabe G, Sako K, Hiwaki T, Hokotate H, Fukukura Y, et al. Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program. Hepatology. 2001;34(3):529–34.
28.
Adachi Y, Kitano S, Sugimachi K. Surgery for gastric cancer:10-year experience worldwide. Gastric Cancer. 2001;4(4):166–74.PubMedCrossRef
Metadata
Title
A New pN Staging System Based on Both the Number and Anatomic Location of Metastatic Lymph Nodes in Gastric Cancer
Authors
Chen Jianhui
Chen Chuangqi
He Yulong
Wu KaiMing
Wu Hui
Cai Shirong
Publication date
01-12-2014
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 12/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-014-2663-5

Other articles of this Issue 12/2014

Journal of Gastrointestinal Surgery 12/2014 Go to the issue

Original Article

Re-examining the BMI Threshold for Bariatric Surgery in the USA

Original Article

Effects of Intravenous Versus Epidural Lidocaine Infusion on Pain Intensity and Bowel Function After Major Large Bowel Surgery: a Double-Blind Randomized Controlled Trial

Original Article

A Prospective Clinical Study Evaluating the Development of Bowel Wall Edema During Laparoscopic and Open Visceral Surgery

Original Article

Morbidity of Loop Ileostomy Closure after Restorative Proctocolectomy for Ulcerative Colitis and Familial Adenomatous Polyposis: a Systematic Review

GI Image

Is Routine Biopsy of Suspicious Liver Lesions Recommended?

Review Article

Single-Incision versus Conventional Multiport Laparoscopic Colorectal Surgery—Systematic Review and Pooled Analysis