J Korean Gastric Cancer Assoc. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Stefano Rausei MD. Reprints and Permissions. Rausei, S. Ann Surg Oncol 18, — Download citation.
Received : 14 June Published : 29 September SEER data contain no identifiers and are publicly available for studies of cancer-based epidemiology and health policy, and thus are exempt from IRB review. Surgical patients were excluded if they had in situ or stage IV disease as determined by extent of disease codes. Patients were also excluded if LN examination and positivity status were unknown. Age, sex, race, TNM stage, tumor grade, tumor histology, tumor location, cause of death and vital status were assessed.
Adjuvant chemotherapy was not considered because this information is not included in the SEER database. In the database, patients were designated into one of three outcome categories: dead from CC, dead from other causes, or alive at the last follow-up. The final models were built in a stepwise fashion that involved forward and backward selection. Goodness of fit for each regression model was evaluated using the Akaike information criterion AIC The PH assumption was checked for the final models using Cox-Snell residual plots.
All the statistical analyses were done using SAS 9. P -values less than 0. The median age at diagnosis was 71 years interquartile range [IQR] and median follow-up was 44 months IQR Patient demographics and pathological features are summarized in Table 3. Flow diagram of patient selection from the , patients with colon cancer to establish patients with stages I-III who had surgical resection with curative intent within the SEER database from Five-year DSS was Similarly, 5-year OS was B DSS for all substages.
Corresponding rates of 5-year DSS were Corresponding rates of 5-year OS were A disease-specific survival, and B overall survival. Multivariable Cox PH survival models were built using a forward and backward, stepwise selection method that incorporated age at diagnosis, sex, race, tumor grade, tumor, size, tumor location, geographic region, radiation therapy, number of LNs examined, LN positivity and AJCC stage.
Statistical analyses were repeated in patients with at least 12 LNs examined and in those with fewer than 12 LNs examined. Since the s, the TNM staging system has defined the extent of a cancer based solely on anatomic pathology.
Revisions to the system are made every years and until recently it has been regarded as the most comprehensive tool for prognostic and predictive grouping of patients with CC 4. Several studies demonstrated that the number of examined LNs impacted survival 12 - 16 , and in the National Quality Forum endorsed examination of at least 12 LNs as a quality measure for CC. Subsequent studies have shown a strong correlation between outcomes and compliance with the LN minimum 6 , 12 , 13 , 17 - This suggests that stage migration due to inadequate LN examination might not be responsible for survival disparities in the AJCC-7 staging system.
In recent years, researchers have recognized the importance of tumorigenesis and the role of non-anatomic markers in establishing the prognosis and anticipated response to therapy 21 - Of particular interest are the seven non-anatomic factors acknowledged by but not incorporated in the AJCC-7 staging system. Of these factors, the circumferential margin of the resected nonperitonealized surface of the specimen CRM is relevant for prognostic assessment of patients with tumors in the ascending and descending colon 27 , These factors have not been incorporated into the staging system because it is not clear how they should be used to determine prognosis 4 or the need for adjuvant chemotherapy.
Also, assessment of these non-anatomic factors adds significantly to a pathologist's workload Our study is one of the largest population-based studies to compare the AJCC-6 and AJCC-7 staging systems while incorporating the quality measure of adequate LN examination, but it does have limitations.
Recurrence data is not available. Also, the SEER database lacks chemotherapy data so we were unable to confirm our suspicion that treatment-related differences contributed to the inferior survival for patients with stage II CC. We also believe that the use of chemotherapy for patients with high-risk stage IIB and IIC CC likely increased during the study period, although chemotherapy for this group remains controversial. AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis TNM in gastric cancer patients.
Patients who underwent surgery without curative intent, patients with tumors of the gastric stump and patients with tumors involving the esophagus were excluded for survival analysis. Patients were staged according to the 6 th and 7 th edition TNM criteria; 5-year overall survival rates were investigated, and the event was defined as death from any cause.
The 5-year overall survival 5-year OS rate of all the patients was New stratification is important in multimodal therapy. Core tip: The 7 th edition of the tumor-node-metastasis TNM staging system appears to exhibit improved accuracy in staging and prognostic stratification with more precise indication for adjuvant and neoadjuvant therapy in the multimodal treatment era.
Our data show the importance of standardization of treatment and the type of surgical lymphadenectomy for comparing different experiences. Further studies are necessary to improve the TNM system, particularly regarding the parameter N and the division into substages.
In addition to age, comorbidities, lesion site, macro- and microscopic type of tumor, quality of surgery and residual tumors, the main factors that influence the long-term survival of patients with gastric cancer are 1 the depth of tumor penetration into the gastric wall T parameter ; 2 the amount of the metastatic regional lymph nodes involved N parameter ; and 3 the presence of distant metastases M parameter.
The tumor-node-metastasis TNM classification of cancer was developed between and by Prof. Pierre Denoix at the Institute Gustave-Roussy. The following are the main objectives of the classifications: to aid the clinician in the planning of treatment, to provide an indication of prognosis, to assist in the evaluation of the results of treatment; to facilitate the exchange of information between treatment centers, to contribute to the continuing investigation of human cancer and to support cancer control activities[ 1 , 2 ].
Particularly, the subserosa infiltration by the tumor, which was previously classified as T2b, is now classified as T3, and the perforation of serosa changed from T3 to T4a. Tumors classified as N1 in the 6 th edition with more than 2 positive nodes are classified as N2 in the 7 th edition, while N2 is classified as N3a, and N3 is classified as N3b.
In the new stratification by stage, the number of substages is increased. According to the 7 th edition, only patients with distant metastases are classified as the fourth stage. Another important change to the criteria concerns distant metastases. In the new edition of the TNM staging system, a positive peritoneal cytology is considered as M1. Several studies, which were mostly performed in eastern countries, have demonstrated the superiority of the 7 th edition TNM criteria and highlighted issues still in dispute for improvement.
The aim of the present study is to compare the sixth and the seventh edition of the TNM classification in patients who underwent surgery for gastric cancer in a single center to confirm the superiority of the new edition regarding its prognostic stratification and reliability.
We considered the parameters T, N and the lymph node ratio LNR individually regardless of stage as additional prognostic parameters. We observed and followed how these changes in the allocation of pT and pN parameters according to the two editions of the classification affect determining the prognosis and the type of treatment for these patients. We retrospectively studied consecutive patients who underwent surgery for gastric adenocarcinoma at the Division of General Surgery, Hospital of Busto Arsizio Varese , Italy from June through December For the survival analysis, we excluded the following patients: 1 patients with distant metastases; 2 patients who underwent surgery without curative intent; 3 patients with tumors of the gastric stump after gastric resection for benign disease; 4 patients with other tumors at the time of diagnosis; and 5 patients with a large involvement of the esophagus requiring total esophagectomy.
None of the patients considered for inclusion in the study underwent neoadjuvant chemotherapy or radiochemotherapy. Because of the heterogeneous and unsystematic indication for adjuvant chemotherapy, treatment protocols and number of cycles, details of the postoperative chemotherapy were not considered in this study.
Regarding the surgical method, en bloc resection of the primary tumor and lymphatic drainage area was routinely performed. The principles of tumor resection and lymphadenectomy by experienced surgeons were similar among all the resected patients. No local excision was performed. Annual follow-ups after 5 years were performed until the patients died. The median follow-up was 48 mo range: mo. Survival curves were estimated using the Kaplan-Meier method[ 5 ].
The overall survival OS rates were investigated, and the event was defined as death for any cause. The aim of this work is to detect the role of MDCT multidetector computed tomography in the preoperative investigation of gastric adenocarcinoma patients according to TNM staging.
But radiological methods are often the initial examination that raises suspicion for gastric carcinoma besides being used in the staging of the disease. Tumor invades muscularis propria. Purpose to prospectively evaluate accuracy of multidetector row computed tomographic ct images for preoperative staging of gastric cancer by using surgical and.
Tumor invades the lamina propria and or muscularis mucosae T1b. Regarding the T-staging the results from previous reports on the usefulness of CT for T-staging of gastric cancer have shown large variations overall accuracy rates of Aim of the Study. MRI is performed with gastric distension using water or effervescent granules.
TNM staging 7 th edition T. This article is based on the 7th edition of the TNM classification of malignant tumors. To prospectively evaluate accuracy of multidetector row computed tomographic CT images for preoperative staging of gastric cancer by using surgical and histopathologic results as refere.
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