[논문]Evaluation of the 7th AJCC TNM Staging System in Point of Lymph Node Classification

Kim, Sung-Hoo; Ha, Tae-Kyung; Kwon, Sung-Joon

doi:10.5230/jgc.2011.11.2.94

Evaluation of the 7th AJCC TNM Staging System in Point of Lymph Node Classification 원문보기

Journal of gastric cancer : jgc, v.11 no.2, 2011년, pp.94 - 100

Kim, Sung-Hoo (Department of Surgery, Hanyang University College of Medicine) , Ha, Tae-Kyung (Department of Surgery, Hanyang University College of Medicine) , Kwon, Sung-Joon (Department of Surgery, Hanyang University College of Medicine)

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Purpose: The 7th AJCC tumor node metastasis (TNM) staging system modified the classification of the lymph node metastasis widely compared to the 6th edition. To evaluate the prognostic predictability of the new TNM staging system, we analyzed the survival rate of the gastric cancer patients assessed by the 7th staging system. Materials and Methods: Among 2,083 patients who underwent resection for gastric cancer at the department of surgery, Hanyang Medical Center from July 1992 to December 2009, This study retrospectively reviewed 5-year survival rate (5YSR) of 624 patients (TanyN3M0: 464 patients, TanyNanyM1: 160 patients) focusing on the number of metastatic lymph node and distant metastasis. We evaluated the applicability of the new staging system. Results: There were no significant differences in 5YSR between stage IIIC with more than 29 metastatic lymph nodes and stage IV (P=0.053). No significant differences were observed between stage IIIB with more than 28 metastatic lymph nodes and stage IV (P=0.093). Distinct survival differences were present between patients who were categorized as TanyN3M0 with 7 to 32 metastatic lymph nodes and stage IV. But patients with more than 33 metastatic lymph nodes did not show any significant differences compared to stage IV (P=0.055). Among patients with TanyN3M0, statistical significances were seen between patients with 7 to 30 metastatic lymph nodes and those with more than 31 metastatic lymph nodes. Conclusions: In the new staging system, modifications of N classification is mandatory to improve prognostic prediction. Further study involving a greater number of cases is required to demonstrate the most appropriate cutoffs for N classification.

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Accordingly in these cases, a statistical analysis could not be performed. Based on the results of the above analysis, in cases which were classified as N3 according to the 7th edition, further efforts are needed to obtain the optimal cut-off value for the number of metastatic lymph nodes. This should be followed by subclassification system.
Of 2,083 patients with gastric cancer who underwent gastrectomy at department of surgery at Hanyang University Medical Center during a period ranging from July of 1992 to December of 2009, in 464 patients without a distant metastasis with no respect to the degree of invasion to the gastric wall whose number of metastatic lymph node was greater than 7 (TanyN3M0) and 160 patients (stage IV) who had a distant metastasis with no respect to the degree of invasion to the gastric wall and the degree of lymph node metastasis based on the degree of lymph node metastasis and the presence of distant metastasis, the survival rate was examined and the validity of TNM staging system was analyzed. Of Stage IV patients, there were 53 cases of sub-total gastrectomy, 51 cases of total gastrectomy, 27 cases of bypass surgery and 29 cases of simple laparotomy.
Of 2,083 patients with gastric cancer who underwent gastrectomy at department of surgery at Hanyang University Medical Center during a period ranging from July of 1992 to December of 2009, in 464 patients without a distant metastasis with no respect to the degree of invasion to the gastric wall whose number of metastatic lymph node was greater than 7 (TanyN3M0) and 160 patients (stage IV) who had a distant metastasis with no respect to the degree of invasion to the gastric wall and the degree of lymph node metastasis based on the degree of lymph node metastasis and the presence of distant metastasis, the survival rate was examined and the validity of TNM staging system was analyzed. Of Stage IV patients, there were 53 cases of sub-total gastrectomy, 51 cases of total gastrectomy, 27 cases of bypass surgery and 29 cases of simple laparotomy.

이론/모형

, Chicago, IL, USA). Survival rate was calculated using a Kaplan-Meier analysis.The difference in the survival rate was analyzed using a log-rank testin order to demonstrate a statistical significance.

성능/효과

But TanyN3aM0 and TanyN3bM0 are classified as the same stage.(2) There are characteristics that the number of metastatic lymph node, based on which the N group is divided into N1 and N2, has a very narrow range but that, based on which it is classified into N3, has a very wide one. Besides, the N3 group is classified into stage IIb, IIIa, IIIb and IIIc although the number of metastatic lymph node is as the greatest can be.
There are also characteristics that no further higher TNM stages could be determined in cases in which the number of metastatic lymph nodes was as the greatest as can be. Based on the results of an analysis in the current study, however, as the number of metastatic lymph nodes was increased even within the same TNM stages,there was no significant difference in the survival rate as comparedwiththehigherTNMstages. Besides,therewas a significant difference in the survival rate despite the same TNM stages.
This suggests that the TNM staging system could not appropriately reflect a prognosis of cases in which the number of metastatic lymph nodes was too great. Based on the results of an analysis of the N3 cases in the current study, following an analysis of the survival rate depending on the number of metastatic lymph node in patients who were classified as the same stage, in patients with stage IIIb or stage IIIc, there was a significant difference in the survival rate between cases inwhichthe number of metastatic lymphnodewas 7~30 and those in which it was greater than 31 (P=0.037 and P＜0.0001, respectively). Of patients with stage IIIb and IIIc, in cases in which the number of metastatic lymph node was greater than 30, there was no significant difference in the survival rate as compared with patients with stage IV.
Following an analysis of the survival rate depending on the number of metastatic lymph node in patientswhowere classified as the same TNM stage, in patients with stage IIIb or stage IIIc, there was a significant difference in the survival rate between cases in which the number of metastatic lymph node was 7~30 and those in which it was greater than 31 (P=0.037, P＜0.0001). Of patients with stage IIIb and IIIc, in cases in which the number of metastatic lymphnodewas greater than 31,therewas no significant difference inthe survival rate as comparedwithpatientswithstage IV(Table 7).
According to the 7th edition, however, cases in which the number of metastatic lymph nodes was greater than 7 were classified as the N3 group. In addition, following a comparison of the survival rate in a stepwise manner at a unit of the number of metastatic lymph nodes of 1 between cases which were classified as TanyN3M0 according to the 7th edition and TanyNanyM1, the difference in the survival rate reached no statistical significance when the number of metastatic lymphnodeswas greater than 33.This phenomenonwas also observed in stage IIIb patients whose number of metastatic lymph nodes was greater than 28 and stage IIIc patients whose number of metastatic lymph nodes was greater than 29.

후속연구

It is necessary, however, to make a differentiation of and then to examine a prognosis of patients whose number of metastatic lymph node is very great of the groupswhose number of metastatic lymph node is greater than 17. Besides, it would also be important to examine whether the new classification system might appropriately reflect a prognosis of the patients with gastric cancer based on the results of the above analysis.

참고문헌 (24)

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Evaluation of the 7th AJCC TNM Staging System in Point of Lymph Node Classification 원문보기

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