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Prognostic value of lymph node staging in gastric cancer
Daisuke Ichikawa1, Hideaki Kurioka, Yasuo Ueshima
1Department of Digestive Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachihirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan. dichikawa@nifty.com
Background/Aims:
The latest TNM classification (5th edition) changed the definition of nodal staging from the anatomical localization to the total number of metastatic lymph nodes. This study was designed to evaluate and compare the prognostic significance of nodal staging between the two widely known staging systems, the TNM classification (TNM) and Japanese Classification for Gastric Cancer (JCGC).
Methodology:
A total of 582 patients who underwent curative gastrectomy with extended lymphadenectomy for gastric cancer were reviewed retrospectively from hospital records. Based on the localization of metastatic nodes according to the JCGC and the total positive node number according to TNM, the patients were divided into subgroups and their prognoses compared.
Results:
Lymph node metastasis was found in 189 of the 582 patients (32.5%). Both nodal staging systems were found to be significant prognostic factors by multivariate analysis. A prognostic analysis of the patients by subdivision with the two staging systems indicated that the nodal staging system in TNM was more homogenous than that of the JCGC.
Conclusions:
The nodal staging system of the TNM classification is superior to that of the Japanese Classification of Gastric Cancer, because it is simple, reproducible and homogeneous.