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. 2013:11 Suppl 1:S90-4.
doi: 10.1016/S1743-9191(13)60025-4.

Lymph node staging in gastric cancer: new criteria, old problems

Stefano Rausei  1 , Gianlorenzo Dionigi  1 , Laura Ruspi  1 , Ilaria Proserpio  2 , Federica Galli  1 , Fabio Tirotta  1 , Francesco Frattini  1 , Francesca Rovera  1 , Luigi Boni  1 , Graziella Pinotti  2 , Renzo Dionigi  1
Affiliations
Free article

Lymph node staging in gastric cancer: new criteria, old problems

Stefano Rausei et al. Int J Surg. 2013.
Free article

Abstract

Purpose: Our study aims to test the prognostic accuracy of the N parameter of the 7th TNM in a Western series of D1-gastrectomies for gastric cancer (GC).

Methods: Retrospectively considering a series of 224 non-metastatic GC patients who underwent surgery with curative intent and limited lymphadenectomy, we analyzed 5-year overall survival (OS) related to pN status according to both TNM editions (pN6 and pN7) and to lymph node ratio (LNR; LNR0, 0%, LNR1, 1-19%; LNR2, > 20%). We stratified pN6- and pN7-related OS by LNR.

Results: Both pN6 and pN7 were shown to significantly stratify different subsets of GC patients, but there was no significant difference between pN71 and pN72, nor between pN62 and pN63. A multivariate model specific for pN7 eliminated the N2 group, while the pN6 model maintained all 3 N groups with highly discriminating hazard ratios. LNR was able to further stratify one category of pN6 (N2) and two categories of pN7 (N1 and N2).

Conclusions: The 7th TNM edition for GC does not seem to be superior to the 6th edition in evaluating the prognostic relevance of lymph-nodal status: in particular, it does not allow an accurate stratification of OS in patients with less than 6 positive lymph nodes.

Keywords: Gastric cancer; Lymph node staging.

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