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 su...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 6thand 7thedition 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%. Thediagnosed stage differed in 32% of 241 patients based on the TNM edition used for the diagnosis. The patients in stage Ⅱ according to the 6thedition 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 6thedition, 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: 7thTNM allows new T2 and N1 patients to be selected with better prognosis, which leads to different staging. New stratification is important in multimodal therapy.展开更多
Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review...Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity,due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases,positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however,its search in clinical practice is still far from being routinely performed,as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently,many controversies on lymph node staging are still ongoing,with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.展开更多
文摘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 6thand 7thedition 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%. Thediagnosed stage differed in 32% of 241 patients based on the TNM edition used for the diagnosis. The patients in stage Ⅱ according to the 6thedition 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 6thedition, 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: 7thTNM allows new T2 and N1 patients to be selected with better prognosis, which leads to different staging. New stratification is important in multimodal therapy.
文摘Seventh tumor-node-metastasis(TNM) classification for gastric cancer,published in 2010,introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity,due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases,positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however,its search in clinical practice is still far from being routinely performed,as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently,many controversies on lymph node staging are still ongoing,with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.
