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Validating the prognostic and discriminating value of the TNM-classification for gastric cancer – A critical appraisal

European Journal of Cancer, Volume 51, Issue 5, March 2015, Pages 577 - 586

Abstract

Aim

We investigated the effect of the new tumour-, node-, metastasis- (TNM) classification on predicting and discriminating gastric cancer patient prognosis using the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program.

Patients and methods

From the SEER-database we retrieved gastric cancer patients with a primary adenocarcinoma, of Caucasian or Asian ethnicity and without distant metastases (M0). The pTNM-stage was determined according to the 7th edition of the union internationale contre le cancer (UICC) guidelines.

Results

Spanning the period 2004–2010, 6136 patients fulfilled all inclusion criteria including 3424 (55.8%) men, 2712 (44.2%) women, 4629 (75.4%) Caucasian and 1507 (24.6%) Asian patients. 1524 (24.8%) patients underwent total gastrectomy and 4612 (75.2%) non-total gastrectomy. Only in 41.2% of the patients were >15 lymph nodes resected. 1857 (31.0%) patients received radiotherapy. Patient survival depended on ethnicity, type of surgery and radiotherapy. The discriminating value of the UICC-stage grouping could not be validated for Caucasian patients with >15 lymph nodes resected and who had not received radiotherapy: stage groups IIB, IIIA, IIIB and IIIC showed substantial overlap in survival ranges. In addition, the tumour specific survival of the different T-/N-combinations was significantly different in stage groups IIIB and IIIC, respectively.

Conclusions

Our retrospective analysis of the SEER-database does not validate the discriminating value of stage grouping of the 7th edition of the UICC-stage grouping. A revision should be considered and more reliable prognostic biomarkers are urgently needed.

Keywords: Gastric cancer, TNM-classification, Prognosis, Stage grouping.

Footnotes

Department of Pathology, Christian-Albrechts-University, Kiel, Germany

Corresponding author at: Department of Pathology, Christian-Albrechts-University, Arnold-Heller-Str. 3, Haus 14, D-24105 Kiel, Germany. Tel.: +49 0 431 597 3401; fax: +49 0 431 597 3462.