Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Hospital and City Key Laboratory of Tianjin Cancer Center, Tianjin, China.
Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Hospital and City Key Laboratory of Tianjin Cancer Center, Tianjin, China.
Surgery. 2014 Jul;156(1):64-74. doi: 10.1016/j.surg.2014.03.020. Epub 2014 Mar 16.
It has recently been reported that the sixth edition of the tumor-node-metastasis (TNM) classification system for gastric cancer involving the staging of regional lymph nodes (N) has inappropriate cut-offs with regard to counts of metastatic lymph nodes. It remains controversial, however, as to whether the seventh edition of this classification system is completely accurate in staging N for the prediction of the prognosis of gastric cancer. Our aim was to determine which of these two editions of the TNM classification system was superior with regard to the prediction of the prognosis of Chinese patients with gastric cancer.
We analyzed relevant clinicopathological data statistically from 1,563 patients with gastric cancer who had undergone curative resection to evaluate the sixth and seventh editions of the TNM classification system for N staging with regard to the prediction of overall survival (OS).
Our survival analyses demonstrated that N staging via use of both the sixth and seventh editions of the TNM classification system was correlated with OS. Furthermore, case-control analysis indicated that the seventh edition was significantly superior to the sixth edition in predicting the OS of patients, regardless of the extent of lymphadenectomy (D1 or D2) and the number of dissected lymph nodes (<16 or ≥16). By taking into consideration both the extent of lymphadenectomy and the number of dissected lymph nodes simultaneously, we determined that the seventh edition of the TNM classification system was superior to the sixth edition regarding the evaluation of the OS in the various subgroups of gastric cancer patients.
The seventh edition proved more reliable and accurate than the sixth edition of the TNM classification system in categorizing the number of metastatic lymph nodes for the purpose of predicting the OS of patients with gastric cancer after curative resection.
最近有报道称，涉及区域淋巴结（N）分期的胃癌第六版肿瘤-淋巴结-转移（TNM）分类系统在转移性淋巴结计数方面的截断值不合适。然而，关于第七版分类系统在预测胃癌患者预后的 N 分期方面是否完全准确仍存在争议。我们的目的是确定这两个 TNM 分类系统版本中哪一个在预测中国胃癌患者的预后方面更具优势。
我们对 1563 例接受根治性切除术的胃癌患者的相关临床病理数据进行了统计学分析，以评估第六版和第七版 TNM 分类系统在预测总体生存率（OS）方面的 N 分期。
我们的生存分析表明，第六版和第七版 TNM 分类系统的 N 分期与 OS 相关。此外，病例对照分析表明，无论淋巴结清扫程度（D1 或 D2）和淋巴结清扫数量（<16 或≥16）如何，第七版均明显优于第六版，用于预测患者的 OS。同时考虑淋巴结清扫程度和淋巴结清扫数量，我们确定第七版 TNM 分类系统在评估各种胃癌患者亚组的 OS 方面优于第六版。
与第六版 TNM 分类系统相比，第七版在分类转移性淋巴结数量方面更可靠和准确，有助于预测接受根治性切除术的胃癌患者的 OS。
