A lymph node staging system for gastric cancer: A hybrid type based on topographic and numeric systems

Yoon Young Choi, Ji Yeong An, Hitoshi Katai, Yasuyuki Seto, Takeo Fukagawa, Yasuhiro Okumura, Dong Wook Kim, Hyoung Il Kim, Jae Ho Cheong, Woo Jin Hyung, Sung Hoon Noh

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Although changing a lymph node staging system from an anatomically based system to a numerically based system in gastric cancer offers better prognostic performance, several problems can arise: it does not offer information on the anatomical extent of disease and cannot represent the extent of lymph node dissection. The purpose of this study was to discover an alternative lymph node staging system for gastric cancer. Data from 6025 patients who underwent gastrectomy for primary gastric cancer between January 2000 and December 2010 were reviewed. The lymph node groups were reclassified into lesser-curvature, greater-curvature, and extra-perigastric groups. Presence of any metastatic lymph node in one group was considered positive. Lymph node groups were further stratified into four (new N0-new N3) according to the number of positive lymph node groups. Survival outcomes with this new N staging were compared with those of the current TNM system. For validation, two centers in Japan (large center, n = 3443; medium center, n = 560) were invited. Even among the same pN stages, the more advanced new N stage showed worse prognosis, indicating that the anatomical extent of metastatic lymph nodes is important. The prognostic performance of the new staging system was as good as that of the current TNM system for overall advanced gastric cancer as well as lymph node-positive gastric cancer (Harrell C-index was 0.799, 0.726, and 0.703 in current TNM and 0.799, 0.727, and 0.703 in new TNM stage). Validation sets supported these outcomes. The new N staging system demonstrated prognostic performance equal to that of the current TNM system and could thus be used as an alternative.

Original languageEnglish
Article numbere0149555
JournalPloS one
Volume11
Issue number3
DOIs
Publication statusPublished - 2016 Mar

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Dissection
stomach neoplasms
Stomach Neoplasms
lymph nodes
Lymph Nodes
Gastrectomy
Lymph Node Excision
Japan
prognosis
Survival

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Choi, Y. Y., An, J. Y., Katai, H., Seto, Y., Fukagawa, T., Okumura, Y., ... Noh, S. H. (2016). A lymph node staging system for gastric cancer: A hybrid type based on topographic and numeric systems. PloS one, 11(3), [e0149555]. https://doi.org/10.1371/journal.pone.0149555
Choi, Yoon Young ; An, Ji Yeong ; Katai, Hitoshi ; Seto, Yasuyuki ; Fukagawa, Takeo ; Okumura, Yasuhiro ; Kim, Dong Wook ; Kim, Hyoung Il ; Cheong, Jae Ho ; Hyung, Woo Jin ; Noh, Sung Hoon. / A lymph node staging system for gastric cancer : A hybrid type based on topographic and numeric systems. In: PloS one. 2016 ; Vol. 11, No. 3.
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Choi, YY, An, JY, Katai, H, Seto, Y, Fukagawa, T, Okumura, Y, Kim, DW, Kim, HI, Cheong, JH, Hyung, WJ & Noh, SH 2016, 'A lymph node staging system for gastric cancer: A hybrid type based on topographic and numeric systems', PloS one, vol. 11, no. 3, e0149555. https://doi.org/10.1371/journal.pone.0149555

A lymph node staging system for gastric cancer : A hybrid type based on topographic and numeric systems. / Choi, Yoon Young; An, Ji Yeong; Katai, Hitoshi; Seto, Yasuyuki; Fukagawa, Takeo; Okumura, Yasuhiro; Kim, Dong Wook; Kim, Hyoung Il; Cheong, Jae Ho; Hyung, Woo Jin; Noh, Sung Hoon.

In: PloS one, Vol. 11, No. 3, e0149555, 03.2016.

Research output: Contribution to journalArticle

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T1 - A lymph node staging system for gastric cancer

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AU - Choi, Yoon Young

AU - An, Ji Yeong

AU - Katai, Hitoshi

AU - Seto, Yasuyuki

AU - Fukagawa, Takeo

AU - Okumura, Yasuhiro

AU - Kim, Dong Wook

AU - Kim, Hyoung Il

AU - Cheong, Jae Ho

AU - Hyung, Woo Jin

AU - Noh, Sung Hoon

PY - 2016/3

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N2 - Although changing a lymph node staging system from an anatomically based system to a numerically based system in gastric cancer offers better prognostic performance, several problems can arise: it does not offer information on the anatomical extent of disease and cannot represent the extent of lymph node dissection. The purpose of this study was to discover an alternative lymph node staging system for gastric cancer. Data from 6025 patients who underwent gastrectomy for primary gastric cancer between January 2000 and December 2010 were reviewed. The lymph node groups were reclassified into lesser-curvature, greater-curvature, and extra-perigastric groups. Presence of any metastatic lymph node in one group was considered positive. Lymph node groups were further stratified into four (new N0-new N3) according to the number of positive lymph node groups. Survival outcomes with this new N staging were compared with those of the current TNM system. For validation, two centers in Japan (large center, n = 3443; medium center, n = 560) were invited. Even among the same pN stages, the more advanced new N stage showed worse prognosis, indicating that the anatomical extent of metastatic lymph nodes is important. The prognostic performance of the new staging system was as good as that of the current TNM system for overall advanced gastric cancer as well as lymph node-positive gastric cancer (Harrell C-index was 0.799, 0.726, and 0.703 in current TNM and 0.799, 0.727, and 0.703 in new TNM stage). Validation sets supported these outcomes. The new N staging system demonstrated prognostic performance equal to that of the current TNM system and could thus be used as an alternative.

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