Published in:
01-01-2016 | Gastrointestinal Oncology
Incorporation of N0 Stage with Insufficient Numbers of Lymph Nodes into N1 Stage in the Seventh Edition of the TNM Classification Improves Prediction of Prognosis in Gastric Cancer: Results of a Single-Institution Study of 1258 Chinese Patients
Authors:
Bofei Li, MD, Yuanfang Li, MD, Wei Wang, PhD, Haibo Qiu, PhD, Sharvesh Raj Seeruttun, MD, Cheng Fang, MD, Yongming Chen, MD, Yao Liang, MD, Wei Li, MD, Yingbo Chen, MD, Xiaowei Sun, MD, Yuanxiang Guan, MD, Youqing Zhan, MD, Zhiwei Zhou, MD
Published in:
Annals of Surgical Oncology
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Issue 1/2016
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Abstract
Purpose
This study examined the prognosis of the “node-negative with eLNs ≤ 15” designation and the additional value of incorporating it into the pN1 designation in the seventh edition of the N classification.
Methods
From January 2000 to September 2010, a total of 1258 gastric cancer patients (patients with eLNs > 15 or node-negative with eLNs ≤ 15) undergoing radical gastric resection were enrolled in this study. We incorporated node-negative patients with eLNs ≤ 15 into pN1 and compared this designation with the current 7th edition UICC N stage for 3, 5-year overall survival by univariate and multivariate analysis. Homogeneity, discriminatory ability, and monotonicity of gradients in the hypothetical N stage and the UICC N stage were compared using linear trend χ2, likelihood ratio χ2 statistics, and Akaike information criterion (AIC) calculations.
Results
Node-negative patients with eLNs ≤ 15 had worse survival compared with those with eLNs > 15. In univariate and multivariate analyses, the hypothetical N stage showed superiority to the 7th edition pN staging. The hypothetical staging system had higher linear trend and likelihood ratio χ
2 scores and smaller AIC values compared with those for the TNM system, which represented the optimum prognostic stratification.
Conclusions
Node-negative patients with eLNs ≤ 15 can be considered to be incorporated into the pN1 stage in the 7th edition of the TNM classification.