Improving the AJCC/TNM Classification for Use in Early Gastric Cancer

Purpose The current TNM classification is still unsatisfactory for collecting all the prognostic information from the clinical presentation of early gastric cancer: “T” is limited to two levels, the classes of “N” are still wide and “M” is generally absent. Patients and Methods This study involved 9...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2011-06, Vol.15 (6), p.935-941
Main Authors: Gobbi, Paolo G., Villano, Lara, Pozzoli, Donatella, Bergonzi, Manuela, Vanoli, Alessandro, Tava, Francesca, Dionigi, Paolo, Corazza, Gino Roberto
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Classification
Female
Gastrectomy
Gastric cancer
Gastroenterology
Gastrointestinal surgery
Humans
Kaplan-Meier Estimate
Lymphatic Metastasis
Lymphatic system
Male
Medical prognosis
Medicine
Medicine & Public Health
Metastasis
Middle Aged
Mortality
Neoplasm Staging - methods
Original Article
Prognosis
Proportional Hazards Models
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
Surgery
Survival Rate
Tumor Burden
Young Adult
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Summary:Purpose The current TNM classification is still unsatisfactory for collecting all the prognostic information from the clinical presentation of early gastric cancer: “T” is limited to two levels, the classes of “N” are still wide and “M” is generally absent. Patients and Methods This study involved 99 patients who underwent radical gastric resection for early gastric cancer. Clinical and histological parameters were prognostically analyzed for both observed and relative survival. Univariate and multivariate analyses were applied to the proportional hazards model. Results Number of metastatic lymph nodes and measure of the largest diameter of the tumor were the only independent prognosticators of observed and relative survival. Their similar relative hazards allowed an additive use of them in the N class. Two cut-off values of this composite clinical parameter are proposed for a good discrimination of the relative survival. Discussion The number of metastatic lymph nodes is the cornerstone of the current TNM system and was confirmed as adequate. The possibility of adding tumor size to the number of the involved lymph nodes improves and amplifies the prognostic ability, which is presently limited by the rarity of lymph node involvement and the small number of the lymph nodes usually involved.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-011-1522-x