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
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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