Abstract
ObjectiveTo demonstrate that the seventh edition of the tumor-node-metastasis (TNM) classification for gastric cancer (GC) should be updated with the number of negative lymph nodes for the improvement of its prognostic prediction accuracy.MethodsClinicopathological data of 769 GC patients who underwent curative gastrectomy with lymphadenectomy between 1997 and 2006 were retrospectively analyzed to demonstrate the superiority of prognostic efficiency of the seventh edition of the TNM classification, which can be improved by combining the number of negative lymph nodes.ResultsWith the Cox regression multivariate analysis, the seventh edition of the TNM classification, the number of negative nodes, the type of gastrectomy, and the depth of tumor invasion (T stage) were identified as independent factors for predicting the overall survival of GC patients. Furthermore, we confirmed that the T stage-N stage–number of negative lymph nodes–metastasis (TNnM) classification is the most appropriate prognostic predictor of GC patients by using case-control matched fashion and multinominal logistic regression. Finally, we were able to clarify that TNnM classification may provide more precise survival differences among the different TNM sub-stages of GC by using the measure of agreement (Kappa coefficient), the McNemar value, the Akaike information criterion, and the Bayesian Information Criterion compared with the seventh edition of the TNM classification.ConclusionThe number of negative nodes, as an important prognostic predictor of GC, can improve the prognostic prediction efficiency of the seventh edition of the TNM classification for GC, which should be recommended for conventional clinical applications.
Highlights
Depth of primary tumor invasion and nodal metastasis are considered as the most intensive factors for predicting the prognosis of gastric cancer (GC) patients after curative surgery
Many retrospective studies have identified that the ratio between the metastatic and the examined lymph nodes was superior to the number of lymph node metastasis in terms of predicating the prognosis of GC as evidenced by the avoidance of the stage migration of malignant disease [4,31]
Recent studies have failed to demonstrate the superiority of the ratio between the metastatic and the examined lymph nodes in evaluating the prognosis of GC compared with the number of lymph node metastasis [2,3]
Summary
Depth of primary tumor invasion and nodal metastasis are considered as the most intensive factors for predicting the prognosis of gastric cancer (GC) patients after curative surgery. The tumor-node-metastasis (TNM) classification of the Union for International Cancer Control (UICC) for GC is considered as the best classification system because of its ability to provide precise prognostic estimation and guidance for patients through appropriate therapeutic programs. Its seventh edition shows a more meticulous prognostic sub-stage than previous editions based on the elaborate redefinitions of depth of primary tumor invasion (T stage) and nodal metastasis (N stage) [1]. More changes have been done to the N stage than the T stage in the latest edition compared with the sixth edition of the TNM classification, thereby establishing a prognostic prediction classification that mainly relies on the reform of the stage of metastatic lymph node count for GC
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