[논문]Evaluation of the 7th UICC TNM Staging System of Gastric Cancer

Kwon, Sung-Joon

doi:10.5230/jgc.2011.11.2.78

Evaluation of the 7th UICC TNM Staging System of Gastric Cancer 원문보기

Journal of gastric cancer : jgc, v.11 no.2, 2011년, pp.78 - 85

Kwon, Sung-Joon (Department of Surgery, Hanyang University College of Medicine)

Abstract ▼ AI-Helper

Since January of 2010, the seventh edition of UICC tumor node metastasis (TNM) Classification, which has recently been revised, has been applied to almost all cases of malignant tumors. Compared to previous editions, the merits and demerits of the current revisions were analyzed. Many revisions have been made for criteria for the classification of lymph nodes. In particular, all the cases in whom the number of lymph nodes is more than 7 were classified as N3 without being differentiated. Therefore, the coverage of the N3 was broad. Owing to this, there was no consistency in predicting the prognosis of the N3 group. By determining the positive cases to a distant metastasis as TNM stage IV, the discrepancy in the TNM stage IV compared to the sixth edition was resolved. In regard to the classification system for an esophagogastric (EG) junction carcinoma, it was declared that cases of an invasion to the EG junction should follow the classification system for esophageal cancer. A review of clinical cases reported from Asian patients suggests that it would be more appropriate to follow the previous editions of the classification system for gastric cancer. In addition, in the classification of the TNM stages in the overall cases, the discrepancy in the prognosis between the different stages and the consistency in the prognosis between the same TNM stages were achieved to a lesser extent as compared to that previously. Accordingly, further revisions are needed to develop a purposive classification method where the prognosis can be predicted specifically to each variable and the mode of the overall classification can be simplified.

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제안 방법

This is quite challenging to surgeons. Further revisions of theTNMstagingwill be needed to contain both of these aspects to develop aharmonized classification.
Given this background, this study analyzed the significance of these changes and examined the matters that need to be considered in the future classification of the disease stage.
In the seventh edition of the UICC TNM staging, which has recently been revised, attempts were made to resolve the problems of previous editions of TNM staging. On the other hand, any noticeable matters have not been resolved.

성능/효과

2% in cases of T1~T4b (n=381). After classifying these cases into the neoadjuvant chemotherapy group and non-neoadjuvant chemotherapy group, the MST was found to be 13 months and 7 months, respectively. According to reports from the Queen Elizabeth Hospital in the UK,(29) in 207 cases of T3 and T4a, the positive rate and MST were 7.
0001). In addition, following a comparison of the survival rate between the TanyN3cM0 group and stage IV based on the degree of the invasion to the gastric wall,there was a significant difference in the survival rate between T3N3cM0 and stage IV and that between T4aN3cM0 and stage IV (P=0.044 and P=0.007, respectively). On the other hand, there was no significant difference in the survival rate between T4bN3cM0 and stage IV.
Of the total cases of gastric cancer surgery, which was performed at large-volume centers in Korea and the USA, the proportion of those in which less than 15 lymph nodes were dissected was 3% and 22%, respectively. A comparison of the survival rate of patients between the two hospitals during the same disease duration revealed the survival rates of patients with stage I/II/III to be significantly higher in Korea compared to USA.

후속연구

This might cause problems in establishing consistency between the TNM stages. According to the methods of the tests and because of the variability in the interpretation of test results, further revisions will be needed to examinewhether a peritonealwashing cytology can be classified as a distant metastasis.
Other aspects are present that would cause many problems with clinical applications due to a very complicated staging system. In consideration of this, further studies will be needed to develop a staging system byharmonizing the two aspects that classifications should be made more specifically and then be uncomplicated.
Nevertheless,there was no significant difference in the survival rate between all the TNM stages (stage I, stage II and stage III) in cases of the EG junction carcinoma, which had been classified based on the classification system for esophageal cancer and gastric cancers occurring at other sites. This suggests that the current revisions might fulfill the classification system for both cancers at distal and proximal sites. Based on these results, there is a higher degree of differences for EG junction carcinomas based on the classification system for gastric cancer rather than the classification system for esophageal cancer (not pressed).

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Evaluation of the 7th UICC TNM Staging System of Gastric Cancer 원문보기

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Evaluation of the 7th UICC TNM Staging System of Gastric Cancer 원문보기

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