A novel lymph node staging system for gastric cancer including modified Union for cancer Control/American Joint Committee on cancer and Japanese Gastric Cancer Association criteria

doi:10.1016/j.ejso.2020.06.005

European Journal of Surgical Oncology

Volume 46, Issue 10, Part B, October 2020, Pages e27-e32

https://doi.org/10.1016/j.ejso.2020.06.005 Get rights and content

Abstract

Background

The TNM system of the International Union for Cancer Control/American Joint Committee on Cancer (UICC/AJCC) and the Japanese Gastric Cancer Association (JGCA) systems are the most used lymph node (LN) staging systems in gastric cancer. This study estimated the influence of anatomic location-based node stations on survival and proposed a new staging method based on both the number and anatomical distribution of metastatic LNs (mLNs).

Methods

Stage I–III gastric cancer patients with radical gastrectomy were retrospectively evaluated. Overall survival (OS) was estimated in 1786 patients with UICC/AJCC stage N1–N3b disease and compared with estimates obtained using JGCA group 1–3 mLN staging.

Results

The OS of UICC/AJCC stage N1–N3b patients with group 2 JGCA mLNs was significantly worse than that of patients with only group 1 mLNs. The OS of the patients with group 2 mLNs was similar to that of patients with group 1 mLNs but in the next more advanced UICC/AJCC-N stage. The OS of patients with group 3 mLNs was worse than that of patients with any UICC/AJCC-N stage and was similar to that of N3b patients with group 2 mLNs. A new pathological node (pN) staging classification was developed that advanced the N-staging of patients with group 2 mLNs. It was a better indicator of prognosis than the eighth UICC/AJCC-N and the thirteenth JGCA group staging systems.

Conclusions

A simple, accurate pN staging system including both the number and location of mLNs had improved homogeneity, discriminatory ability, and gradient monotonicity.

Section snippets

Background

Gastric cancer is the sixth most prevalent malignancy worldwide and the third leading cause of cancer-related deaths. An estimated one million new cases and 782,685 gastric cancer deaths occurred in 2018 [1]. Surgical resection is the primary gastric cancer treatment, and accurate staging is critical for achieving good clinical outcomes. Lymph node (LN) metastasis affects the prognosis of gastric cancer, and the most used LN staging systems are the TNM system of the International Union for

Patient selection and study design

A group of 3076 patients with radical surgery for gastric cancer at the First Hospital of China Medical University, Shenyang, Liaoning, China between January 1980 and December 2012 were retrospectively evaluated. The patients had been staged following the criteria in the eighth edition of the UICC/AJCC Cancer Staging Manual [2]. Eligible patients had a postoperative pathological diagnosis of primary gastric adenocarcinoma, no history of previous gastric surgery, no adjuvant therapy before

Clinical pathology

A total of 1786 patients, 1289 men and 497 women from 26 to 83 years of age and a median age of 58 (IQR, 50–66) years met the conditions for inclusion. Follow-up ranged from 1 to 426 months with a median of 36.0 months and a mean of 86.4 months. No patients were lost to follow-up. Their demographics and pathological characteristics are shown in Table 1.

Prognosis of patients with mLNs in JGCA groups 1 and 2

The survival of patients with the same UICC/AJCC-N stage and in either JGCA group 1 or group 2 is shown in Fig. 1. The prognosis of group 1

Discussion

This study investigated the prognostic impact of mLNs in groups 1, 2, and 3 in 1786 patients with gastric cancer staged with the UICC/AJCC-N system and treated with radical surgery. Patients with group 2 mLNs had a significantly worse prognosis than N1–N3b-stage patients who were only metastasized to group 1. For patients with group 3 mLNs, the prognosis was worse than that of patients in any N stage. Those results led to a revised nodal group (Ng) classification that was a better indicator of

Conclusions

A simple and accurate pN staging system based on the number and location of mLNs was an effective indicator of prognosis associated with the OS of gastric patients after radical surgery. The revised Ng staging had improved homogeneity, discriminatory ability, and gradient monotonicity compared with UICC/AJCC-N and the JGCA-N staging.

CRediT authorship contribution statement

Yingbo Gong: Formal analysis, Data curation, Writing - original draft. Siwei Pan: Formal analysis, Data curation. Xin Wang: Funding acquisition. Guolian Zhu: Writing - original draft. Huimian Xu: Writing - original draft. Zhi Zhu: Writing - original draft.

Declaration of competing interest

The authors declare that they have no competing interests.

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A novel lymph node staging system for gastric cancer including modified Union for cancer Control/American Joint Committee on cancer and Japanese Gastric Cancer Association criteria

Abstract

Background

Methods

Results

Conclusions

Section snippets

Background

Patient selection and study design

Clinical pathology

Prognosis of patients with mLNs in JGCA groups 1 and 2

Discussion

Conclusions

CRediT authorship contribution statement

Declaration of competing interest

Lancet Oncol

Surgery

Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

CA A Cancer J Clin

AJCC cancer staging manual

Japanese classification of gastric carcinoma – 2nd English Edition

Gastric Cancer

Japanese classification of gastric carcinoma: 3rd English edition

Gastric Cancer

Gastric cancer, version 3.2016, NCCN clinical practice guidelines in oncology

J Natl Compr Canc Netw

Increasing the number of examined lymph nodes is a prerequisite for improvement in the accurate evaluation of overall survival of node-negative gastric cancer patients

Ann Surg Oncol

Log odds of positive lymph nodes: a novel prognostic indicator superior to the number-based and the ratio-based N category for gastric cancer patients with R0 resection

Cancer