Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy.
Department of General Surgery Unit, Campus Bio-Medico of Rome University, Italy.
Surg Oncol. 2020 Sep;34:223-233. doi: 10.1016/j.suronc.2020.04.022. Epub 2020 May 16.
The current Tumor Node Metastasis staging system (TNM) for gastric cancer classifies the extent of lymph node metastasis based upon the number of lymph nodes involved. Choi et al. have recently proposed a new anatomical classification based upon the regionality of the involved nodes. This new classification seems to have a better predictive prognostic value than the traditional one. We investigated the prognostic role of the new anatomical based classification, reviewing our institutional gastric cancer database.
We performed a retrospective chart review of 329 patients who underwent gastrectomy at our Institution from 2003 to 2017. We excluded from data analysis any patient with distant metastases at the time of first diagnosis and or surgery, pathology other than adenocarcinoma, lymphadenectomy less than D2, impossibility to identify location of lymph nodes (LNs) on pathological report and neoadjuvant chemotherapy. The extent of D2 lymphadenectomy was defined according to Japanese Gastric Cancer Association criteria. LN metastasis were reclassified into three topographic groups (lesser, greater curvature, and extraperigastric nodes) and staged according to Choi. The new N stage was combined with the current pT according to the 8th edition of TNM and a new hybrid TNM stage was established. All patients were followed up until June 2019. The prognostic performance of the new stage and of the current anatomical numeric based system (TNM) was analyzed and assessed by the C-index, AIC and likelihood ratio χ value.
In predicting both Overall Survival (OS) and Disease free Survival (DFS) the new N stage and the new TNM staging system had the highest C-index and likelihood ratio χ2 value and the lowest Akaike Information Criterion (AIC), showing a better accuracy and displaying a better prognostic performance.
Our study is the first from the Western world to compare the new hybrid classification, based on the anatomical location of metastatic nodes, to the 8th of American Joint Committee on Cancer (AJCC) TNM staging system. Our findings on a small, monocentric sample suggest that hybrid topographic lymph node staging system is more accurate than TNM.
目前的胃癌 TNM 分期系统（TNM）根据受累淋巴结的数量对淋巴结转移的程度进行分类。Choi 等人最近提出了一种基于受累淋巴结区域的新解剖分类。这种新分类似乎比传统分类具有更好的预测预后价值。我们通过回顾性分析我们机构的胃癌数据库，研究了新解剖分类的预后作用。
我们对 2003 年至 2017 年在我们机构接受胃切除术的 329 名患者进行了回顾性图表审查。我们排除了任何在首次诊断和/或手术时存在远处转移、病理不是腺癌、淋巴结清扫少于 D2、病理报告无法识别淋巴结（LN）位置以及新辅助化疗的患者。D2 淋巴结清扫的程度根据日本胃癌协会标准定义。LN 转移被重新分类为三个拓扑组（较小的、胃大弯和胃外节点），并根据 Choi 分期。新的 N 期与当前的 pT 根据第 8 版 TNM 联合，建立了新的混合 TNM 分期。所有患者均随访至 2019 年 6 月。通过 C 指数、AIC 和似然比 χ 值分析和评估新分期和当前解剖数字分期系统（TNM）的预后性能。
在预测总生存期（OS）和无病生存期（DFS）方面，新的 N 期和新的 TNM 分期系统具有最高的 C 指数和似然比 χ2 值，以及最低的 Akaike 信息准则（AIC），表明准确性更高，预后性能更好。
我们的研究是西方世界首次将基于转移性淋巴结解剖位置的新混合分类与第 8 版美国癌症联合委员会（AJCC）TNM 分期系统进行比较。我们在一个小的、单中心样本上的发现表明，混合拓扑淋巴结分期系统比 TNM 更准确。
