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Updated: Mar 29, 2026

Elastic Staining on Paraffin-embedded Slides of pT3N0M0 Gastric Cancer Tissue

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Published on: May 1, 2019

Incomplete TNM Documentation in Gastric Cancer: Frequency, Phenotype, and Treatment Allocation.

Alexandru-Marian Vieru¹, Maria-Lorena Mustață¹, Virginia-Maria Rădulescu²

¹Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.

Diagnostics (Basel, Switzerland)

|March 28, 2026

Summary

Incomplete TNM staging is common in gastric cancer patients, impacting treatment decisions. Advanced disease phenotypes significantly influence surgical allocation, highlighting the need for explicit staging documentation.

Keywords:

TNM staging gastric cancer metastatic disease phenotypes real-world evidence treatment allocation tumor markers

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Area of Science:

Oncology
Gastroenterology
Clinical Research

Background:

Real-world gastric cancer data often lacks complete TNM staging documentation.
Incomplete staging complicates the interpretation of disease stage, phenotype, and treatment strategies.
Accurate staging is crucial for effective gastric cancer management.

Purpose of the Study:

To quantify the completeness of TNM staging in a real-world gastric cancer cohort.
To describe the phenotype of advanced gastric cancer at diagnosis.
To examine treatment selection patterns based on disease stage and phenotype.

Main Methods:

Retrospective observational study of 419 consecutive gastric cancer patients.
Analysis of TNM components, metastatic status, and surgical treatment.
Definition of incomplete staging as missing TNM components (Tx, Nx, Mx).
Logistic regression to assess associations with metastatic disease (M1) and treatment allocation.

Main Results:

36.8% of patients had incomplete TNM staging.
M status was defined in 89.5% of cases, with 52.0% diagnosed with metastatic disease (M1).
Surgical rates differed significantly: 34.4% for M1 vs. 73.3% for M0 patients.
Surgical allocation was highest in M0-LAM (89.1%) and lowest in M1 (48.4%) phenotypes.

Conclusions:

Incomplete staging is prevalent and clinically significant in real-world gastric cancer data.
Explicit reporting of staging completeness is recommended.
Phenotype-based summaries offer a practical approach to understanding advanced disease and guiding treatment selection.
Tumor markers require cautious interpretation without predefined cut-offs.