Prognostic Value of the Anatomic Region of Metastatic Lymph Nodes in the Current TNM Staging of Gastric Cancer

Overview

Journal J Gastric Cancer

Date 2021 Oct 25

PMID 34691808

Citations 3

Authors

Oh Jeong

Mi Ran Jung

Ji Hoon Kang

Affiliations

Soon will be listed here.

Abstract

Purpose: The numeric N stage has replaced the topographic N stage in the current tumor node metastasis (TNM) staging in gastric carcinoma. However, the usefulness of the topographic N stage in the current TNM staging system is uncertain. We aimed to investigate the prognostic value of the topographic N stage in the current TNM staging system.

Materials And Methods: We reviewed the data of 3350 patients with gastric cancer who underwent curative gastrectomy. The anatomic regions of the metastatic lymph nodes (MLNs) were classified into 2 groups: perigastric and extra-perigastric. The prognostic value of the anatomic region was analyzed using a multivariate prognostic model with adjustments for the TNM stage.

Results: In patients with lymph node metastasis, extra-perigastric metastasis demonstrated significantly worse survival than perigastric metastasis alone (5-year survival rate, 39.6% vs. 73.1%, respectively, P<0.001). Extra-perigastric metastasis demonstrated significantly worse survival within the same pN stage; the multivariate analysis indicated that extra-perigastric metastasis was an independent poor prognostic factor (hazard ratio=1.33; 95% confidence interval=1.01-1.75). The anatomic region of the MLNs improved the goodness-of-fit (likelihood ratio statistics, 4.57; P=0.033) of the prognostic model using the TNM stage.

Conclusions: The anatomic region of MLNs has an independent prognostic value in the numeric N stage in the current TNM staging of gastric carcinoma.

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References

. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011; 14(2):113-23. DOI: 10.1007/s10120-011-0042-4. View

Yoo C, Noh S, Kim Y, Min J . Comparison of prognostic significance of nodal staging between old (4th edition) and new (5th edition) UICC TNM classification for gastric carcinoma. International Union Against Cancer. World J Surg. 1999; 23(5):492-7; discussion 497-8. DOI: 10.1007/pl00012337. View

Sung H, Ferlay J, Siegel R, Laversanne M, Soerjomataram I, Jemal A . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71(3):209-249. DOI: 10.3322/caac.21660. View

Galizia G, Lieto E, Auricchio A, Cardella F, Mabilia A, Diana A . Comparison of the current AJCC-TNM numeric-based with a new anatomical location-based lymph node staging system for gastric cancer: A western experience. PLoS One. 2017; 12(4):e0173619. PMC: 5381862. DOI: 10.1371/journal.pone.0173619. View

Lauricella S, Caricato M, Masciana G, Carannante F, Carnazza M, Bonaccorso A . Topographic lymph node staging system shows prognostic superiority compared to the 8th edition of AJCC TNM in gastric cancer. A western monocentric experience. Surg Oncol. 2020; 34:223-233. DOI: 10.1016/j.suronc.2020.04.022. View

Ichikura T, Tomimatsu S, Uefuji K, Kimura M, Uchida T, Morita D . 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. DOI: 10.1002/(sici)1097-0142(19990815)86:4<553::aid-cncr2>3.0.co;2-d. View

Qiu M, Qiu H, Wang Z, Ren C, Wang D, Zhang D . The tumor-log odds of positive lymph nodes-metastasis staging system, a promising new staging system for gastric cancer after D2 resection in China. PLoS One. 2012; 7(2):e31736. PMC: 3279377. DOI: 10.1371/journal.pone.0031736. View

Han D, Suh Y, Kong S, Lee H, Choi Y, Aikou S . Nomogram predicting long-term survival after d2 gastrectomy for gastric cancer. J Clin Oncol. 2012; 30(31):3834-40. DOI: 10.1200/JCO.2012.41.8343. View

Marchet A, Mocellin S, Ambrosi A, Morgagni P, Garcea D, Marrelli D . The ratio between metastatic and examined lymph nodes (N ratio) is an independent prognostic factor in gastric cancer regardless of the type of lymphadenectomy: results from an Italian multicentric study in 1853 patients. Ann Surg. 2007; 245(4):543-52. PMC: 1877031. DOI: 10.1097/01.sla.0000250423.43436.e1. View

10.

Nio Y, Tsubono M, Kawabata K, Masai Y, Hayashi H, Meyer C . Comparison of survival curves of gastric cancer patients after surgery according to the UICC stage classification and the General Rules for Gastric Cancer Study by the Japanese Research Society for gastric cancer. Ann Surg. 1993; 218(1):47-53. PMC: 1242899. DOI: 10.1097/00000658-199307000-00008. View

11.

Lirosi M, Biondi A, Ricci R . Surgical anatomy of gastric lymphatic drainage. Transl Gastroenterol Hepatol. 2017; 2:14. PMC: 5388628. DOI: 10.21037/tgh.2016.12.06. View

12.

Kong S, Lee H, Ahn H, Kim J, Kim W, Lee K . Stage migration effect on survival in gastric cancer surgery with extended lymphadenectomy: the reappraisal of positive lymph node ratio as a proper N-staging. Ann Surg. 2011; 255(1):50-8. DOI: 10.1097/SLA.0b013e31821d4d75. View

13.

Ilson D . Advances in the treatment of gastric cancer. Curr Opin Gastroenterol. 2018; 34(6):465-468. DOI: 10.1097/MOG.0000000000000475. View

14.

. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011; 14(2):101-12. DOI: 10.1007/s10120-011-0041-5. View

15.

Woo Y, Son T, Song K, Okumura N, Hu Y, Cho G . A Novel Prediction Model of Prognosis After Gastrectomy for Gastric Carcinoma: Development and Validation Using Asian Databases. Ann Surg. 2016; 264(1):114-20. DOI: 10.1097/SLA.0000000000001523. View

16.

. Korean Practice Guideline for Gastric Cancer 2018: an Evidence-based, Multi-disciplinary Approach. J Gastric Cancer. 2019; 19(1):1-48. PMC: 6441770. DOI: 10.5230/jgc.2019.19.e8. View

17.

Fujii K, Isozaki H, Okajima K, Nomura E, Niki M, Sako S . Clinical evaluation of lymph node metastasis in gastric cancer defined by the fifth edition of the TNM classification in comparison with the Japanese system. Br J Surg. 1999; 86(5):685-9. DOI: 10.1046/j.1365-2168.1999.01115.x. View

18.

Choi Y, An J, Katai H, Seto Y, Fukagawa T, Okumura Y . A Lymph Node Staging System for Gastric Cancer: A Hybrid Type Based on Topographic and Numeric Systems. PLoS One. 2016; 11(3):e0149555. PMC: 4788413. DOI: 10.1371/journal.pone.0149555. View

19.

. The general rules for The gastric cancer study in surgery. Jpn J Surg. 1973; 3(1):61-71. DOI: 10.1007/BF02469463. View

20.

Chen M, Chan C, Lin Y, Yen H . Anatomical location-based nodal staging system is superior to the 7th edition of the American Joint Committee on Cancer staging system among patients with surgically resected, histologically low-grade gastric cancer: A single institutional experience. PLoS One. 2019; 14(2):e0211836. PMC: 6363228. DOI: 10.1371/journal.pone.0211836. View