Brief Article
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World Journal of Gastrointestinal Surgery. Nov 27, 2013; 5(11): 287-293
Published online Nov 27, 2013. doi: 10.4240/wjgs.v5.i11.287
Sixth and seventh tumor-node-metastasis staging system compared in gastric cancer patients
Tommaso Zurleni, Elson Gjoni, Andrea Ballabio, Roberto Casieri, Paola Ceriani, Luca Marzoli, Francesco Zurleni
Tommaso Zurleni, Elson Gjoni, Andrea Ballabio, Roberto Casieri, Paola Ceriani, Francesco Zurleni, Department of General Surgery, Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy
Luca Marzoli, Department of Medical Physics, Hospital of Busto Arsizio, 21052 Busto Arsizio, Italy
Author contributions: Zurleni T, Gjoni E, Zurleni F contribuited to the study conception, study design and data interpretation; Zurleni T, Gjoni E wrote the paper; Zurleni T, Gjoni E, Ballabio A, Casieri R, Ceriani P analyzed data; Marzoli L performed the statistical analysis; Zurleni F supervised the study.
Correspondence to: Tommaso Zurleni, MD, Department of General Surgery, Hospital of Busto Arsizio, Piazzale Solaro 3, 21052 Busto Arsizio, Italy. tzurleni@yahoo.it
Telephone: +39-331-699716 Fax: +39-331-699578
Received: July 10, 2013
Revised: October 1, 2013
Accepted: October 17, 2013
Published online: November 27, 2013
Abstract

AIM: To investigate the clinical relevance and prognosis regarding survival according to the changes of the tumor-node-metastasis (TNM) in gastric cancer patients.

METHODS: We retrospectively studied 347 consecutive subjects who underwent surgery for gastric adenocarcinoma at the Division of General Surgery, Hospital of Busto Arsizio, Busto Arsizio, Italy between June 1998 and December 2009. 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 6th and 7th edition TNM criteria; 5-year overall survival rates were investigated, and the event was defined as death from any cause.

RESULTS: After exclusion, our study population included 241 resected patients with curative intent for gastric adenocarcinoma. The 5-year overall survival (5-year OS) rate of all the patients was 52.8%. The diagnosed stage differed in 32% of 241 patients based on the TNM edition used for the diagnosis. The patients in stage II according to the 6th edition who were reclassified as stage III had significantly worse prognosis than patients classified as stage II (5-year OS, 39% vs 71%). According to the 6th edition, 135 patients were classifed as T2, and 75% of these patients migrated to T3 and exhibited a significantly worse prognosis than those who remained T2, regardless of lymph node involvement (37% vs 71%). The new N1 patients exhibited a better prognosis than the previous N1 patients (67% vs 43%).

CONCLUSION: 7th TNM allows new T2 and N1 patients to be selected with better prognosis, which leads to different staging. New stratification is important in multimodal therapy.

Keywords: Gastric cancer, Tumor-node-metastasis staging system, Survival analysis, Prognostic factor, Lymphadenectomy

Core tip: The 7th 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.