Objective： The Union for International Cancer Control （UICC） Node （N） classification is the most common used staging method for the prognosis of gastric cancer. It demands adequate, at least 16 lymph nodes （LNs...Objective： The Union for International Cancer Control （UICC） Node （N） classification is the most common used staging method for the prognosis of gastric cancer. It demands adequate, at least 16 lymph nodes （LNs） to be dissected; therefore different staging systems were invented. Methods： Between March 2005 and March 2010, 164 patients were evaluated at the Department of General Surgery in the Ken^zy Gyula Hospital and at the Department of General, Thoracic and Vascular Surgery in the Kaposi M6r Hospital. The 6th, 7th and 8th UICC N-staging systems, the number of examined LNs, the number of harvested negative LNs, the metastatic lymph node ratio （MLR） and the log odds of positive LNs （LODDS） were determined to measure their 5-year survival rates and to compare them to each other. Results： The overall 5year survival rate for all patients was 55.5% with a median overall survival time of 102 months. The tumor stage, gender, UICC N-stages, MLR and the LODDS were significant prognostic factors for the 5-year survival with univariate analysis. The 6th UICC N-stage did not follow the adequate risk in comparing N2 vs. NO and N3 vs. NO with multivariate investigation. Comparison of performances of the residual N classifications proved that the LODDS system was first in the prediction of prognosis during the evaluation of all patients and in cases with less than 16 harvested LNs. The MLR gave the best prognostic prediction when adequate （more than or equal to 16） lymphadenectomy was performed. Conclusions： We suggest the application of LODDS system routinely in western patients and the usage of MLR classification in cases with extended lymphadenectomy.展开更多
Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review...Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity,due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases,positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however,its search in clinical practice is still far from being routinely performed,as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently,many controversies on lymph node staging are still ongoing,with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.展开更多
Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)s...Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)staging strategy to homogenize the nodal classification of GC cohorts comprising of both<16(Limited set)and≥16(Adequate set)rLNs.Methods:All patients in this study underwent R0 gastrectomy.The overall survival(OS)difference between the Limited and Adequate set from a large Chinese multicenter dataset was analyzed.Using the 8th American Joint Committee on Cancer(AJCC)pathological nodal classification(pN)for GC as base,a modified nodal classification(N’)resembling similar analogy as the 8th AJCC pN classification was developed.The performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance,Epidemiology,and End Results(SEER)dataset comprising of 10,208 multi-ethnic GC cases.Results:Significant difference in OS between the Limited and Adequate set(corresponding N0–N3a)using the 8th AJCC system was observed but the OS of N0_(limited)vs.N1_(adequate),N1_(limited)vs.N2_(adequate),N2_(limited)vs.N3_(aadequate),and N3_(alimited)vs.N3_(badequate)subgroups was almost similar in the Chinese dataset.Therefore,we formulated an N’classification whereby only the nodal subgroups of the Limited set,except for pT1N0M0 cases as they underwent less extensive surgeries(D1 or D1+gastrectomy),were re-classified to one higher nodal subgroup,while those of the Adequate set remained unchanged(N’0=N0_(adequate)+pT1N0M0_(limited),N’1=N1_(adequate)+N0_(limited)(excluding pT1N0M0_(limited)),N’2=N2_(adequate)+N1_(limited),N’3a=N3_(aadequate)+N2_(limited),and N’3b=N3_(badequate)+N3_(alimited)).This N’classification demonstrated less heterogeneity in OS between the Limited and Adequate subgroups.Further analyses demonstrated superior statistical performance of the pTN’M system over the 8th AJCC edition and was successfully validated using the SEER dataset.Conclusion:The pr展开更多
AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis(TNM) in gastric cancer patients. METHODS: We retrospectively studied 347 consecutive su...AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis(TNM) in gastric cancer patients. METHODS: We retrospectively studied 347 consecutive subjects who underwent surgery for gastric adenocarcinoma at the Division of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy between June 1998 and December 2009. Patients who underwent surgery without curative intent, patients with tumors of the gastric stump and patients with tumors involving the esophagus were excluded for survival analysis. Patients were staged according to the 6thand 7thedition TNM criteria; 5-year overall survival rates were investigated, and the event was defined as death from any cause. RESULTS: After exclusion, our study population included 241 resected patients with curative intent for gastric adenocarcinoma. The 5-year overall survival(5-year OS) rate of all the patients was 52.8%. Thediagnosed stage differed in 32% of 241 patients based on the TNM edition used for the diagnosis. The patients in stage Ⅱ according to the 6thedition who were reclassified as stage Ⅲ had significantly worse prognosis than patients classified as stage Ⅱ(5-year OS, 39% vs 71%). According to the 6thedition, 135 patients were classifed as T2, and 75% of these patients migrated to T3 and exhibited a significantly worse prognosis than those who remained T2, regardless of lymph node involvement(37% vs 71%). The new N1 patients exhibited a better prognosis than the previous N1 patients(67% vs 43%). CONCLUSION: 7thTNM allows new T2 and N1 patients to be selected with better prognosis, which leads to different staging. New stratification is important in multimodal therapy.展开更多
Gastric cancer remains one of the leading malignancies in China. The history of modern surgical treatment of gastric cancer could be dated back to the early fifties with an overall 5-year survival rate of around 10%. ...Gastric cancer remains one of the leading malignancies in China. The history of modern surgical treatment of gastric cancer could be dated back to the early fifties with an overall 5-year survival rate of around 10%. Remarkable progress has been achieved ever since in terms of operability, resectability and 5-year survival rate which ranges now from 30% to over 50% after radical resection. In regard to problems and future perspective, apart from the effort which should be redoubled in increasing the detection rate of EGC, the need to popularize the new international TNM staging system, to carry out in-depth studies on the biological behavior of gastric cancers and the role of the spleen in the evolution of gastric cancer, and to include new potential adjuvant measures in the therapeutic regimen of AGC are emphasized.展开更多
文摘Objective： The Union for International Cancer Control （UICC） Node （N） classification is the most common used staging method for the prognosis of gastric cancer. It demands adequate, at least 16 lymph nodes （LNs） to be dissected; therefore different staging systems were invented. Methods： Between March 2005 and March 2010, 164 patients were evaluated at the Department of General Surgery in the Ken^zy Gyula Hospital and at the Department of General, Thoracic and Vascular Surgery in the Kaposi M6r Hospital. The 6th, 7th and 8th UICC N-staging systems, the number of examined LNs, the number of harvested negative LNs, the metastatic lymph node ratio （MLR） and the log odds of positive LNs （LODDS） were determined to measure their 5-year survival rates and to compare them to each other. Results： The overall 5year survival rate for all patients was 55.5% with a median overall survival time of 102 months. The tumor stage, gender, UICC N-stages, MLR and the LODDS were significant prognostic factors for the 5-year survival with univariate analysis. The 6th UICC N-stage did not follow the adequate risk in comparing N2 vs. NO and N3 vs. NO with multivariate investigation. Comparison of performances of the residual N classifications proved that the LODDS system was first in the prediction of prognosis during the evaluation of all patients and in cases with less than 16 harvested LNs. The MLR gave the best prognostic prediction when adequate （more than or equal to 16） lymphadenectomy was performed. Conclusions： We suggest the application of LODDS system routinely in western patients and the usage of MLR classification in cases with extended lymphadenectomy.
文摘Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity,due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases,positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however,its search in clinical practice is still far from being routinely performed,as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently,many controversies on lymph node staging are still ongoing,with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.
基金the National Natural Science Foundation of China(81802451)the China Postdoctoral Science Foundation(2017M622879)+1 种基金the Natural Science Foundation of Guangdong Province(2114050002182,2018A030313827 and 2021A1515011327)the Young Teacher Training Program of Sun Yat-sen University(19ykpy172).
文摘Background:Currently,there is no formal consensus regarding a standard classification for gastric cancer(GC)patients with<16 retrieved lymph nodes(rLNs).Here,this study aimed to validate a practical lymph node(LN)staging strategy to homogenize the nodal classification of GC cohorts comprising of both<16(Limited set)and≥16(Adequate set)rLNs.Methods:All patients in this study underwent R0 gastrectomy.The overall survival(OS)difference between the Limited and Adequate set from a large Chinese multicenter dataset was analyzed.Using the 8th American Joint Committee on Cancer(AJCC)pathological nodal classification(pN)for GC as base,a modified nodal classification(N’)resembling similar analogy as the 8th AJCC pN classification was developed.The performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance,Epidemiology,and End Results(SEER)dataset comprising of 10,208 multi-ethnic GC cases.Results:Significant difference in OS between the Limited and Adequate set(corresponding N0–N3a)using the 8th AJCC system was observed but the OS of N0_(limited)vs.N1_(adequate),N1_(limited)vs.N2_(adequate),N2_(limited)vs.N3_(aadequate),and N3_(alimited)vs.N3_(badequate)subgroups was almost similar in the Chinese dataset.Therefore,we formulated an N’classification whereby only the nodal subgroups of the Limited set,except for pT1N0M0 cases as they underwent less extensive surgeries(D1 or D1+gastrectomy),were re-classified to one higher nodal subgroup,while those of the Adequate set remained unchanged(N’0=N0_(adequate)+pT1N0M0_(limited),N’1=N1_(adequate)+N0_(limited)(excluding pT1N0M0_(limited)),N’2=N2_(adequate)+N1_(limited),N’3a=N3_(aadequate)+N2_(limited),and N’3b=N3_(badequate)+N3_(alimited)).This N’classification demonstrated less heterogeneity in OS between the Limited and Adequate subgroups.Further analyses demonstrated superior statistical performance of the pTN’M system over the 8th AJCC edition and was successfully validated using the SEER dataset.Conclusion:The pr
文摘AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis(TNM) in gastric cancer patients. METHODS: We retrospectively studied 347 consecutive subjects who underwent surgery for gastric adenocarcinoma at the Division of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy between June 1998 and December 2009. Patients who underwent surgery without curative intent, patients with tumors of the gastric stump and patients with tumors involving the esophagus were excluded for survival analysis. Patients were staged according to the 6thand 7thedition TNM criteria; 5-year overall survival rates were investigated, and the event was defined as death from any cause. RESULTS: After exclusion, our study population included 241 resected patients with curative intent for gastric adenocarcinoma. The 5-year overall survival(5-year OS) rate of all the patients was 52.8%. Thediagnosed stage differed in 32% of 241 patients based on the TNM edition used for the diagnosis. The patients in stage Ⅱ according to the 6thedition who were reclassified as stage Ⅲ had significantly worse prognosis than patients classified as stage Ⅱ(5-year OS, 39% vs 71%). According to the 6thedition, 135 patients were classifed as T2, and 75% of these patients migrated to T3 and exhibited a significantly worse prognosis than those who remained T2, regardless of lymph node involvement(37% vs 71%). The new N1 patients exhibited a better prognosis than the previous N1 patients(67% vs 43%). CONCLUSION: 7thTNM allows new T2 and N1 patients to be selected with better prognosis, which leads to different staging. New stratification is important in multimodal therapy.
文摘Gastric cancer remains one of the leading malignancies in China. The history of modern surgical treatment of gastric cancer could be dated back to the early fifties with an overall 5-year survival rate of around 10%. Remarkable progress has been achieved ever since in terms of operability, resectability and 5-year survival rate which ranges now from 30% to over 50% after radical resection. In regard to problems and future perspective, apart from the effort which should be redoubled in increasing the detection rate of EGC, the need to popularize the new international TNM staging system, to carry out in-depth studies on the biological behavior of gastric cancers and the role of the spleen in the evolution of gastric cancer, and to include new potential adjuvant measures in the therapeutic regimen of AGC are emphasized.
