Department of Surgical Oncology and General Surgery, Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, PR China.
Department of Surgical Oncology, Shenyang Cancer Hospital, Shenyang, 110001, Liaoning, PR China.
Eur J Surg Oncol. 2020 Oct;46(10 Pt B):e27-e32. doi: 10.1016/j.ejso.2020.06.005. Epub 2020 Jun 23.
The TNM system of the International Union for Cancer Control/American Joint Committee on Cancer (UICC/AJCC) and the Japanese Gastric Cancer Association (JGCA) systems are the most used lymph node (LN) staging systems in gastric cancer. This study estimated the influence of anatomic location-based node stations on survival and proposed a new staging method based on both the number and anatomical distribution of metastatic LNs (mLNs).
Stage I-III gastric cancer patients with radical gastrectomy were retrospectively evaluated. Overall survival (OS) was estimated in 1786 patients with UICC/AJCC stage N1-N3b disease and compared with estimates obtained using JGCA group 1-3 mLN staging.
The OS of UICC/AJCC stage N1-N3b patients with group 2 JGCA mLNs was significantly worse than that of patients with only group 1 mLNs. The OS of the patients with group 2 mLNs was similar to that of patients with group 1 mLNs but in the next more advanced UICC/AJCC-N stage. The OS of patients with group 3 mLNs was worse than that of patients with any UICC/AJCC-N stage and was similar to that of N3b patients with group 2 mLNs. A new pathological node (pN) staging classification was developed that advanced the N-staging of patients with group 2 mLNs. It was a better indicator of prognosis than the eighth UICC/AJCC-N and the thirteenth JGCA group staging systems.
A simple, accurate pN staging system including both the number and location of mLNs had improved homogeneity, discriminatory ability, and gradient monotonicity.
国际癌症控制联盟/美国癌症联合委员会 (UICC/AJCC) 和日本胃癌协会 (JGCA) 的 TNM 系统是胃癌中使用最广泛的淋巴结 (LN) 分期系统。本研究估计基于解剖位置的节点站对生存的影响，并提出了一种基于转移 LN (mLN) 数量和解剖分布的新分期方法。
回顾性评估接受根治性胃切除术的 I-III 期胃癌患者。在 1786 例 UICC/AJCC N1-N3b 期患者中评估总生存期 (OS)，并与 JGCA 组 1-3 mLN 分期的估计值进行比较。
UICC/AJCC N1-N3b 期具有 JGCA 组 2 mLN 的患者的 OS 明显差于仅具有组 1 mLN 的患者。具有组 2 mLN 的患者的 OS 与具有组 1 mLN 的患者相似，但在下一个更先进的 UICC/AJCC-N 期。具有组 3 mLN 的患者的 OS 比任何 UICC/AJCC-N 期患者差，与具有组 2 mLN 的 N3b 患者相似。开发了一种新的病理性淋巴结 (pN) 分期分类，该分类提高了具有组 2 mLN 的患者的 N 分期。它是比第八版 UICC/AJCC-N 和第十三版 JGCA 组分期系统更好的预后指标。
一种简单、准确的包括 mLN 数量和位置的 pN 分期系统提高了均质性、区分能力和梯度单调性。
