Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain.
Complutense University of Madrid, Madrid, Spain.
Am J Clin Pathol. 2021 Oct 13;156(5):749-765. doi: 10.1093/ajcp/aqab031.
The TNM classification is the main tool for lymph node (LN) staging in gastric cancer (GC). However, alternative LN staging systems have been proposed, and the role of features other than the number of metastatic LNs is being investigated. Our aim is to discuss the main challenges of LN assessment in GC.
Comprehensive review of the literature on alternative LN staging systems, examined LNs, sentinel LN (SLN) biopsy, LN micrometastases (LNMIs), extracapsular extension (ECE), and tumor deposits (TDs) in GC.
Many controversies exist regarding LN assessment in GC. The TNM classification shows excellent prognostic performance, but alternative prognostic methods such as the LN ratio or log odds of positive LNs have demonstrated to be better than the TNM system in terms of prognostic accuracy. The value of SLN biopsy and LNMIs in GC is still unclear, and several challenges concerning their clinical impact and pathologic analysis must be overcome before their introduction in clinical practice. Most authors have identified ECE and TDs as independent prognostic factors for survival in GC.
Further studies should be performed to evaluate the impact of these features on the TNM classification and patient outcomes, as well as to standardize alternative LN staging systems.
TNM 分类是胃癌（GC）淋巴结（LN）分期的主要工具。然而，已经提出了替代的 LN 分期系统，并且正在研究除转移 LN 数量以外的特征的作用。我们的目的是讨论 GC 中 LN 评估的主要挑战。
对替代 LN 分期系统、检查 LN、前哨淋巴结 (SLN) 活检、LN 微转移 (LNMIs)、包膜外扩展 (ECE) 和肿瘤沉积物 (TDs) 在 GC 中的文献进行全面复习。
GC 中 LN 评估存在许多争议。TNM 分类显示出出色的预后性能，但替代预后方法，如 LN 比或阳性 LN 的对数优势，在预后准确性方面优于 TNM 系统。SLN 活检和 LNMIs 在 GC 中的价值仍不清楚，在将其引入临床实践之前，必须克服其临床影响和病理分析方面的许多挑战。大多数作者已经确定 ECE 和 TDs 是 GC 生存的独立预后因素。
应进行进一步的研究，以评估这些特征对 TNM 分类和患者结局的影响，并标准化替代 LN 分期系统。
