第 6 版与第 7 版 TNM 分期对胃癌患者预后预测的比较分析

目的：分析胃癌第7版TNM分期的临床应用价值.方法：对比分析874例胃癌术后患者第6版和7版TNM分期 与预后的关系.结果：第6版Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb、Ⅳ期的5年生存率分别为98.1%、83.0%、56.5%、26.6%、20.6%和14.1%,差异有统计学意义（P=0.000）;第7版Ⅰa、Ⅰb、Ⅱa、Ⅱb、Ⅲa、Ⅲb、Ⅲc、Ⅳ期的5年生存率分别为98.1%、86.8%、80.4%、60.0%、40.6%、24.5%、15.4% 和0,差异有统计学意义 （P=0.000）.第6版Ⅱ期细分为第7版Ⅱa、Ⅱb和Ⅲa期,5年生存率差异有统计学意义（P=0.005）;第6版Ⅳ期细分为第7版Ⅲa、Ⅲb、Ⅲc和Ⅳ期,5年生存率差异有统计学意义（P=0.017）.第7版Ⅲ期增加最多,Ⅰ期减少最多.结论：第7版TNM分期更加详细,能够准确预测胃癌的预后.     

AJCC第7版与第6版胃癌TNM分期的比较:一项基于预后分析的918例中国胃癌人群的回顾性研究

目的:本研究旨在评价美国癌症联合会(American Joint Committee on Cancer,AJCC)第7版胃癌TNM分期系统在判断预后方面是否优于AJCC第6版胃癌TNM分期系统.方法:对2003年1月-2008年12月单一中心的918例胃癌患者分别采用AJCC第6版和第7版胃癌TNM分期系统进行重新分期,采用单因素和多因素分析评价这2种胃癌TNM分期系统在判断预后中的价值.采用Akaike信息标准(Akaike's Information Criterion,AIC)评价这2个分期系统的优劣.结果:AJCC第7版胃癌TNM分期系统中,T、N和M分期亚组的总生存时间差异有统计学意义.对患者进行Ⅰ～Ⅳ期临床分期,则无论是按照AJCC胃癌TNM分期系统第6版还是第7版,Ⅰ～Ⅳ期这4条生存曲线的差异均有统计学意义(P值均为0.000);按照AJCC第7版胃癌TNM分期系统的8个亚分期,ⅠA期和ⅠB期、ⅠB期和Ⅱ A期、Ⅱ B期和Ⅲ A期、Ⅲ A期和Ⅲ B期以及Ⅲ B期和Ⅲ C期的生存曲线差异均无统计学意义(P=0.643、P=0.267、P=0.534、P=0.124、P=0.174).AJCC第7版胃癌TNM分期系统的AIC值小于第6版.结论:AJCC第7版胃癌TNM分期系统在预测预后价值方面要优于第6版,但前者的优势十分有限,且存在一定缺陷.     

国际抗癌联盟和日本胃癌协会胃癌淋巴结分期法与国人胃癌患者预后相关性的比较

目的 比较国际抗癌联盟(UICC)和日本胃癌协会(JGCA)两种胃癌淋巴结分期法与胃癌预后的相关性,评价其在胃癌预后评估中的指导意义和应用价值.方法 1996年1月至2005年12月间,经D2及以上胃癌根治手术,清扫淋巴结数目≥15枚,并有完整随访资料的395例胃癌患者为研究对象,分别以两种淋巴结分期法进行分期并绘制生存曲线.以Kaplan-Meier法进行生存率分析,Log rank检验评估组间的差异.结果 按UICC法分期后,各组间患者的生存率差异更明显.对T3期患者分别以两种方法分组并进行生存率比较显示,按照UICC法分期各组间的差异更明显.对两种分期后的N亚期以另一种标准相互再分期后,生存曲线显示,以UICC法对JGCA法分期后的各组再分期所产生的差异比以JGCA法对UICC法分期后的各组再分期后所产生的差异明显.在JGCA分期标准中,Ⅰa、Ⅰb、Ⅱ、Ⅲa、Ⅲb和Ⅳ期患者的5年生存率分别为100.0%、96.9%、79.3%、54.2%、16.8%和11.2%;在UICC TNM分期标准中,其5年生存率分别为100.0%、96.9%、75.4%、51.8%、18.4%和10.5%.各期患者的5年生存率差异均无统计学意义(P>0.05).结论 UICC TNM胃癌分期标准与预后的相关性更好,对胃癌患者的预后评估和治疗方案的制定有更为客观的指导意义;而施行标准的D2胃癌根治手术和清扫至少15枚淋巴结是实行UICC分期法所必需的.     

新TNM分期系统对评价手术切除肝癌预后的意义

背景与目的2002年国际抗癌联盟对原第5版肝癌TNM(以下简称TNM5)分期进行了修订,提出了新的第6版TNM(以下简称TNM6)分期标准,目前应用TNM6分期评估手术切除肝癌患者预后的报道较少。本研究探讨TNM6分期对评价手术切除肝癌预后的价值及TNM6分期在我国临床应用的可行性和合理性。方法根据我院1993年1月至1998年12月施行的478例肝细胞肝癌切除病例资料和随访结果,分别按TNM5分期及TNM6分期进行生存分析,比较各期的生存率,并将TNM5分期和TNM6分期作相互比较,分析TNM6分期的优缺点。结果按TNM5分期标准各期病例数分别为Ⅰ期12例(2.5%),Ⅱ期224例(46.8%),ⅢA期95例(19.9%),ⅢB期8例(1.7%)和ⅣA期139例(29.1%);各期患者5年生存率分别为81.8%、41.5%、17.0%、0.0%和10.2%。Ⅰ期与Ⅱ期、ⅢB与ⅣA期患者生存率无统计学差异;Ⅱ、ⅢA、ⅢB期患者间在预后上有显著差别。按TNM6分期标准各期病例数分别为Ⅰ期234例(48.9%),Ⅱ期41例(8.6%),ⅢA期96例(20.1%),ⅢB期88例(18.4%)和ⅢC期19例(4.0%);各期患者5年生存率分别为43.3%、20.2%、13.1%、13.0%和0。Ⅰ期与Ⅱ期患者生存率有统计学差异,Ⅱ期、ⅢA期与ⅢB期患者互相之间生存率均无显著差异。结论肝癌TNM6分期较TNM5分期有重要进步,参数较少,且简便易用,但仍有一定局限性,临床应用于预后估计还不十分准确,并不完全适用于我国绝大多数合并肝硬化的肝癌患者。     

第7版UICC TNM分期系统回顾性分析胃癌预后的预测价值研究

[目的]评估第7版UICCTNM分期系统对胃癌患者预后的预测价值。[方法]回顾性分析浙江大学医学院附属第二医院2003年6月至2005年9月行手术切除且资料齐全的胃癌136例,按照第7版TNM分期,预后指标行Kaplan-Meier分析,选择有显著差异指标行Cox多因素分析。[结果]胃癌患者5年生存率为40.0%。单因素分析发现手术方式、浸润深度、淋巴结转移数目、第7版TNM分期是预后影响因素。多因素分析结果显示浸润深度、第7版TNM分期、手术方式是影响预后的独立危险因素。第6版中N1拆分为第7版的N1和N2两组,5年生存率分别为48.2%和31.1%（P=0.000）。[结论]第7版TNM分期系统能准确预测胃癌预后。     

第6版和第7版UICC-AJCC TNM分期系统预测食管癌根治性切除术后生存情况的比较:基于400例食管癌患者的临床分析

目的:本研究旨在比较第6版和第7版国际抗癌联盟-美国癌症联合委员会(Union for International Cancer Control-American Joint Committeeon Cancer,UICC-AJCC)TNM分期系统在判断食管癌患者预后中的价值。方法:研究对象为2006年8月—2009年9月在本院接受食管癌根治性切除术的400例食管癌患者,并按照第6版和第7版UICC-AJCC食管癌TNM分期系统分别进行TNM分期和临床分期。应用单因素分析(Kaplan-Meier法)和多因素分析(COX比例风险模型)探讨食管癌患者的预后相关因素。结果:无论是按照第6版还是第7版UICC-AJCC食管癌TNM分期系统,Ⅰ、Ⅱ以及Ⅲ+Ⅳ期患者的3年总生存率差异均有统计学意义(P<0.000)。按照第7版UICC-AJCC食管癌TNM分期系统,ⅢA、ⅢB和ⅢC期患者的3年总生存率差异有统计学意义(P=0.001);N0、N1、N2和N3患者的3年总生存率分别为71.8%、54.4%、31.6%和25.0%,差异有统计学意义(P<0.000)。COX比例风险模型多因素分析结果显示,无论是按照第6版还是第7版,肿瘤大小、分化程度、浸润深度(T分期)和区域淋巴结转移(N分期)因素均是食管癌根治性切除术后的独立预后因素(P<0.05)。结论:第6版还是第7版UICC-AJCC食管癌TNM分期系统均能较好地预测食管癌根治性切除术后患者的预后,肿瘤大小、分化程度、浸润深度(T分期)和区域淋巴结转移(N分期)因素都是重要的独立预后因素。鉴于第7版UICC-AJCC食管癌TNM分期系统更加细致,因此它能够更加准确地预测预后,对食管癌患者的临床治疗具有更佳的指导意义。     

基于第六版AJCC分期的乳腺癌临床分析

目的比较1997年第五版和2002年第六版AJCC的病理分期标准对乳腺癌预后预测的不同点。方法1996年～1999年治疗157例早期女性乳腺癌患者,根据我们医院的存档资料,按照第五版和第六版的AJCC分期系统进行重新病理分期并随访;主要观察目标为不同分期下的无复发生存率和生存期,用Kaplan-Meier和log-rank进行统计学检验。结果第五版Ⅱ期例数有93例,在第六版分期则只有64例(68.8%)仍是Ⅱ期,其中Ⅱa期例数无变化,Ⅱb期71例中有42.3%(30/71)产生了分期的变化。第五版Ⅰ期患者无复发,Ⅱ和Ⅲ期的无复发生存率有差别,平均无复发生存期分别为77.1个月和64.8个月,但无显著性差异(Log-RankP=0.069)。第六版Ⅰ期患者无复发,Ⅱ和Ⅲ期的无复发生存率亦有明显差别,平均无复发生存期分别为81.2个月和65.4个月,有显著性差异(Log-RankP=0.029)。结论由于体现了淋巴结侵犯的数目,AJCC第六版TNM病理分期系统定义了更多的Ⅲ期患者,Ⅱ、Ⅲ期患者间的无复发生存率具有更显著的差别,较第五版分期系统有了进一步改进,新的分期系统一样适用于中国乳腺癌患者。     

回顾性分析第8版AJCC/UICC TNM分期系统在预测Ⅰa期肺腺癌预后中的价值

目的:评估第8版AJCC/UICC TNM分期系统对Ⅰa期肺腺癌患者预后的预测价值。方法:回顾性分析郑州人民医院2007年1月至2012年7月行手术切除且病理资料齐全的Ⅰa期肺腺癌患者90例,按照第8版TNM分期系统,预后指标行Kaplan-Meier 分析,选择有显著差异指标行Cox多因素分析。结果:Ⅰa期肺腺癌患者总体5年生存率为84.4%。Kaplan-Meier单因素分析发现年龄、性别、吸烟状态、发病部位、ALK基因状态、EGFR基因状态、手术方式、辅助治疗不影响Ⅰa期肺腺癌患者预后;而肿瘤病理类型、组织分级及第8版TNM分期影响Ⅰa期肺腺癌患者的预后。Cox多因素分析结果显示第8版 TNM分期是影响Ⅰa期肺腺癌患者预后的独立危险因素。第7版中Ⅰa1期和Ⅰa2期拆分为第8版的Ⅰa1期、Ⅰa2期、Ⅰa3期三组,5年生存率分别为96.9%、88.9%、67.7%（P=0.002）。结论:第8版TNM分期系统能更准确预测Ⅰa期肺腺癌患者的预后。     

AJCC第7版与第8版分期对乳腺癌患者预后预测的比较分析

背景与目的：美国癌症联合委员会（American Joint Committee on Cancer,AJCC）第8版乳腺癌分期在传统解剖因素基础上,结合生物标志物,建立了一种全新的乳腺癌预后分期系统。该研究旨在分析AJCC第8版乳腺癌分期的临床应用价值。方法：分析222例乳腺癌根治术后出现复发转移的患者,按照AJCC第7版解剖分期：肿瘤（tumor,T）分期、淋巴结（node,N）分期、转移（metastasis,M）分期,和第8版预后分期标准进行初诊状态再分期,比较不同标准分期的差异及与预后的关系,生存分析采用Kaplan-Meier方法,log-rank法检验无病生存期（disease-free survival,DFS）的差异。结果：按照AJCC第7版分期标准,ⅠA、ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期的患者分别为34例（15.3%）、0例（0.0%）、73例（32.9%）、26例（11.7%）、45例（20.3%）、4例（1.8%）和40例（18.0%）;按照AJCC第8版预后分期标准,ⅠA、ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期的患者分别为47例（21.2%）、35例（15.8%）、55例（24.8%）、17例（7.7%）、25例（11.3%）、30例（13.5%）和13例（5.9%）,差异有统计学意义（P=0.000）。分期变化主要有：第7版Ⅰ期细分为第8版ⅠA和ⅠB期;第7版ⅡA期细分为第8版ⅠA、ⅠB和ⅡA期;第7版ⅡB期细分为第8版ⅠA、ⅠB、ⅡA、ⅡB和ⅢA期;第7版ⅢA期细分为第8版ⅠB、ⅡA、ⅡB、ⅢA、ⅢB和ⅢC期;第7版ⅢB和ⅢC期细分为第8版ⅢA、ⅢB和Ⅲc期。AJCC第7版TNM分期和第8版预后分期与患者DFS比较差异均有统计学意义（P=0.002和0.001）,第8版预后分期ⅢB和ⅢC期亚组的DFS更为准确。结论： AJCC第8版预后分期能够准确预测乳腺癌患者的预后。     

美国癌症研究联合会第七版肿瘤分期对鼻咽癌放疗预后的影响

目的 观察美国癌症研究联合会( AJCC)第7版肿瘤分期标准对鼻咽癌常规放疗(CRT)和凋强放疗(IMRT)预后的影响.方法 用AJCC第7版肿瘤TNM分期标准对本院2004-2006年接受CRT和IMRT的鼻咽癌患者重新分期和分析预后.共1138例患者入组,CRT 790例,IMRT 348例.CRT和IMRT患者中位年龄分别为47岁和45岁(x2 =1.49,P=0.222),男女比例分别为580∶210和266∶82(x2=1.15,P=0.303),Ⅰ、Ⅱ、Ⅲ、Ⅳ期例数分别为0、41、488、261和5、65、176、102例(x2 =64.78,P=0.001).比较两种放疗的3年疗效,Kaplan-Meier法计算生存率并Logrank法检验.结果 3年随访率为96.0％.常规、IMRT患者中位随访时间分别为32、33个月,死亡例数分别为113、35例.N分期是影响常规、IMRT总生存和无远处转移生存的因素(x2 =6.50、13.60,P=0.038、0.004和X2=7.78、15.30,P=0.009、0.002),临床分期对CRT总生存有影响(x2=6.70,P=0.035)、对IMRT无远处转移生存有影响(x2=9.12,P=0.028).结论 第7版AJCCT分期仍不能满足准确判断鼻咽癌预后的需要,N分期是影响鼻咽癌总生存和无远处转移生存的重要预后因素.     

Evaluation of the Seventh American Joint Committee on Cancer/International Union Against Cancer Classification of gastric adenocarcinoma in comparison with the sixth classification

BACKGROUND:

The seventh TNM staging system for gastric cancer of the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) had a more detailed classification than the sixth TNM staging system for both the tumor (T) and lymph nodes (N). The authors compared survival rates assessed by the seventh staging system with those by the sixth system.

METHODS:

The authors analyzed the prospectively collected database on patients with gastric cancer who underwent surgery at Seoul National University Hospital between 1986 and 2006, and calculated the survival rates of 9998 cases with primary cancer, R0 resection, and >14 retrieved lymph nodes.

RESULTS:

The 5‐year cumulative survival rates (5YSR) according to the seventh edition T or N classifications were significantly different. The 5YSR according to seventh edition of the TNM staging system were 95.1% (stage IA), 88.4% (stage IB), 84.0% (stage IIA), 71.7% (stage IIB), 58.4% (stage IIIA), 41.3% (stage IIIB), and 26.1% (stage IIIC), which were significantly different from each other. The 5YSR of the seventh edition T2 and T3 classifications had significant differences in patients with every N classification, and the 5YSR of seventh edition N1 and N2 classifications had significant differences in T2 patients, T3 patients, and T4 patients. Each stage in the sixth edition was divided into the seventh edition stage with different survival rates. In addition, the number of homogenous groupings in seventh edition TNM stages was increased from 1 to 2.

CONCLUSIONS:

The seventh system provided a more detailed classification of prognosis than the sixth system, especially between T2 and T3 tumors and N1 and N2 tumors, although further studies were found to be needed for the N3a and N3b classification. Cancer 2010. © 2010 American Cancer Society.     

食管癌新旧分期系统预后价值的比较

目的：比较第7 版和第6 版AJCC食管癌分期系统对可切除的食管鳞癌患者的预后评估的差异。方法：选取天津医科大学附属肿瘤医院1999年1 月至2004年12月间398 例食管鳞状细胞癌术后有完整资料患者的临床病理和5 年随访资料,通过Kaplan-Meier 生存曲线法描述生存过程,Log-Rank检验不同分期的生存率的差异,χ2检验比较组间差异。结果：按照AJCC第6 版及第7 版两种不同的TNM分期方法对398 例患者的临床病理结果进行分期,总的5 年生存率为26.9% 。新分期后,由于转移淋巴结数目和肿瘤分化程度的标准不同,Ⅰ期及Ⅳ期的例数均有所增加,各期别生存差异较第6 版更加显著。其5 年生存率分别为62.5% ,33.9% ,15% ,3.4% 。结论：AJCC食管癌第7 版分期能够更好的反映食管癌术后患者的预后,转移淋巴结数目的对预后的影响更显重要。     

Validation of the seventh edition of the American Joint Committee on Cancer TNM staging system for gastric cancer

BACKGROUND:

The seventh edition of the American Joint Committee on Cancer (AJCC) TNM classification for gastric cancer was published in 2010 and included major revisions. The aim of the current study was to evaluate the validity of the seventh edition TNM classification for gastric cancer based on an Asian population.

METHODS:

A total of 2916 gastric cancer patients who underwent R0 surgical resection from 1989 through 2008 in a single institute were included, and were analyzed according to the seventh edition of the TNM classification for validation.

RESULTS:

When adjusted using the seventh edition of the TNM classification, upstaging was observed in 771 patients (26.4%) and downstaging was observed in 178 patients (6.1%) compared with the sixth edition of the TNM classification. The relative risk (RR) of seventh edition pT classification was found to be increased with regular intensity compared with the sixth edition pT classification. The RR of seventh edition pN classification was found to be increased with irregular intensity compared with the sixth edition pN classification. In survival analysis, there were significant differences noted for each stage of disease, but only a marginal difference was demonstrated between stage IA and stage IB (P = .049). In the hybrid TNM classification, which combines the seventh edition pT classification and the sixth edition pN classification, both pT and pN classifications demonstrated a more ideal distribution of the RR, and 5‐year survival rates also showed a significant difference for each stage (P <.01).

CONCLUSIONS:

The seventh edition of the TNM classification was considered valid based on the results of the current study. However, the hybrid TNM classification, comprised of a combination of the seventh edition pT classification and sixth edition pN classification, should be considered for the next edition. Cancer 2011. © 2011 American Cancer Society.     

Validation study of the UICC TNM classification of malignant tumors,seventh edition,in breast cancer

Background

The TNM classification of the Unio Internationalis Contra Cancrum was revised for the seventh edition. The major change concerning breast cancer is a change in the stages for patients with T0 or T1N1miM0. In the present study, the seventh edition of the TNM classification was validated in breast cancer.

Methods

The stages of 416 breast cancer patients, treated at our hospital in 1996, were classified according to the TNM classification, sixth and seventh editions, and their prognoses were compared.

Results

Case distribution using the sixth edition was stage 0, 56 cases (13.5 %); stage I, 158 cases (38.0 %); stage II, 130 [A, 102; B, 28] cases (31.2 [A, 24.5; B, 6.7] %); and stage III, 72 [A, 31; B, 8; C, 33] cases (17.3 [A, 7.5; B, 1.9; C, 7.9] %). According to the seventh edition, the stages for 20 patients, accounting for 19.6 % of IIA cases according to the sixth edition, decreased from IIA to IB. The 10-year overall survivals were stage 0, 91.1 %; stage I, 88.6 %; stage II, 80.8 %; and stage III, 63.9 % according to the sixth edition; and stage 0, 91.1 %; stage I, 88.8 %; stage II, 79.1 %; and stage III, 63.9 % according to the seventh edition. Although no significant differences were seen among the survival rates for stages 0 to II according to the sixth edition, there was a significant difference between stage I and II according to the seventh edition (p = 0.026).

Conclusion

The latest revision of the TNM classification is appropriate for breast cancer from the perspective of prognosis.     

A retrospective prognostic evaluation analysis using the 8th edition of American Joint Committee on Cancer (AJCC) cancer staging system for luminal A breast cancer

Objective:We retrospectively analyzed the clinical prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for luminal A breast cancer.Methods:Using both the anatomic and prognostic staging in the 8th edition of AJCC cancer staging system,we restaged patients with luminal A breast cancer treated at the Breast Disease Center,Peking University First Hospital from 2008 to 2014.Follow-up data including 5-year disease free survival (DFS),overall survival (OS) and other clinic-pathological data were collected to analyze the differences between the two staging subgroups.Results:This study included 421 patients with luminal A breast cancer (median follow-up,61 months).The 5-year DFS and OS rates were 98.3％ and 99.3％,respectively.Significant differences in 5-year DFS but not OS were observed between different anatomic disease stages.Significant differences were observed in both 5-year DFS and OS between different prognostic stages.Application of the prognostic staging system resulted in assignment of 175 of 421 patients (41.6％) to a different group compared to their original anatomic stages.In total,102 of 103 patients with anatomic stage ⅡA changed to prognostic stage ⅠB,and 24 of 52 patients with anatomic stage ⅡB changed to prognostic stage ⅠB,while 1 changed to prognostic stage ⅢB.Twenty-two of 33 patents with anatomic stage ⅢA were down-staged to ⅡA when staged by prognostic staging system,and the other 11 patients were down-staged to ⅡB.Two patients with anatomic stage ⅢB were down-staged to ⅢA.Among seven patients with anatomic stage ⅢC cancer,two were down-staged to ⅢA and four were down-staged to stage ⅢB.Conclusions:The 8th edition of AJCC prognostic staging system is an important supplement to the breast cancer staging system.More clinical trials are needed to prove its ability to guide selection of proper systemic therapy and predict prognosis of breast cancer.     

原发性胃肠道恶性淋巴瘤术后生存期的影响因素及TNM分期对远期生存的预测价值分析

目的 探讨原发性胃肠道恶性淋巴瘤术后生存期的影响因素及TNM分期对远期生存的预测价值。方法 纳入我院收治的原发性胃肠道恶性淋巴瘤患者102例,对患者临床资料进行回顾性分析。通过电话随访明确其术后5年内的生存情况与生存时间,采用Cox回归分析观察原发性胃肠道恶性淋巴瘤患者生存期的影响因素,利用Kaplan-Meier绘制生存曲线图分析TNM分期对患者生存期的预测价值。结果 在102例患者中,死亡41例,占全部病例的40.20%;生存组无远处转移、TNM分期Ⅰ~Ⅱ期、Lugano分期Ⅰ~Ⅱ期占比高于死亡组,差异有统计学意义(P＜0.05);以TNM进行分期时,患者Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期5年内的生存率分别为54.10%、21.31%、16.39%、8.20%。以Lugano进行分期时,患者Ⅰ期、Ⅱ期、ⅡE期、Ⅳ期5年内的生存率分别为52.46%、22.95%、13.11%、11.48%,经Cox回归分析提示远处转移、TNM分期、Lugano分期与患者生存期有关(P＜0.05);TNM分期对患者远期生存率的预测优于Lugano分期。结论 胃恶性淋巴瘤患者远期生存期的影响因素包括远处转移、TNM分期以及Lugano分期,与Lugano分期比较,TNM分期对远期生存期的预测效果更理想。     

N stages of the seventh edition of TNM Classification are the most intensive variables for predictions of the overall survival of gastric cancer patients who underwent limited lymphadenectomy

The objective of this study was to explore the prognostic prediction rationality of the seventh edition N stage for gastric cancer (GC) patients who underwent the limited lymphadenectomy. Clinicopathological data of 769 GC patients who underwent the curative resection between 1997 and 2006 were analyzed for demonstration that the seventh edition N stage had the significant superiorities of prognostic prediction to the patients who underwent the limited lymphadenectomy. Although the extent of lymphadenectomy was associated with the overall survival (OS) of gastric cancer (GC) patients, the N stages of the seventh edition of the TNM Classification were identified as the most intensively independent predictors of GC prognosis. Using stratum analysis, the 5-year survival rate of patients who underwent limited lymphadenectomy was observed to be significantly different from that of patients who underwent extended lymphadenectomy, regardless of the extent of lymph node metastasis. Multinomial logistic regression analysis revealed that combining the extents of lymph node metastasis and lymphadenectomy could improve the prediction accuracy of patient survival status. Case control analysis showed that regardless of the extent of lymphadenectomy, the seventh edition N stages featured significant superiority for OS evaluation of GC patients. The seventh edition N stage had the prediction rationality for the OS of GC patients who underwent the limited lymphadenectomy.