Proposal of a New TNM Classification for Gastric Cancer: Focusing on pN3b and Cytology-Positive (CY1) Disease
- Author:
Sa Hong KIM
1
;
Hyuk Joon LEE
;
Ji Hyeon PARK
;
Jong Ho CHOI
;
Shin Hoo PARK
;
Hwi Nyeong CHOE
;
Seung Young OH
;
Yun Suhk SUH
;
Seong Ho KONG
;
Do Joong PARK
;
Han Kwang YANG
Author Information
- Publication Type:Original Article
- Keywords: Classification; Surgery
- MeSH: Classification; Drug Therapy; Humans; Lymph Nodes; Neoplasm Metastasis; Retrospective Studies; Seoul; Stomach Neoplasms; Survival Rate
- From:Journal of Gastric Cancer 2019;19(3):329-343
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: Gastric cancer with lymph node metastasis (LNM) more than 15 (N3b) was defined as stage IV until the 6th AJCC system. However, it has been reclassified as a localized disease (stage IIb or III) since the 7th system. The aim of this study is to demonstrate that the survival of N3b is comparable to cytology-only positive (CY1-only) stage IV and to propose a new TNM system interpreting N3b as an eligibility criterion for receiving more intensive chemotherapy regimens. MATERIALS AND METHODS: 1,430 patients who underwent gastric cancer surgery at Seoul National University Hospital from 2007 to 2012 were retrospectively analyzed. The 5-year survival rate (5YSR) and 3-year recurrence-free survival (RFS) were evaluated according to the 7th and 8th systems, as well as a new categorization based on N-classification; N0-2 (LNM<7), N3a (LNM 7–15), or N3b (LNM>15). RESULTS: The survival of N3b is comparable to that of CY1-only stage IV (log rank test, P=0.671) and is distinct from that of grossly stage IV (log rank test, P<0.001). The survival of the remaining stage IIIc (T4bN3a) was comparable to those of N3b and CY1-only stage IV. Most N3b patients had significantly shorter 3-year RFS and mean RFS than those with IIb–IIIc, as if N3b itself was a higher TNM stage. CONCLUSIONS: In terms of survival, T4bN3a, N3b, and CY1-only stage IV were unified as stage IVa, while grossly stage IV was defined as stage IVb. N3b can be regarded as an eligibility criterion for undergoing more intensive chemotherapy regimens.
