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The new TNM classification of lymph node metastasis minimises stage migration problems in gastric cancer patients

By G de Manzoni, G Verlato, F Roviello, P Morgagni, A Di Leo, L Saragoni, D Marrelli, H Kurihara and F Pasini


The present study aimed at investigating whether in gastric cancer patients stage migration occurs with extension of lymphadenectomy, when node metastases are staged according to the new pN classification (UICC 1997). The investigation involved 921 patients, who underwent R0 gastric resection for gastric cancer between 1988 and 1998 in three different Italian centres: Verona (n=236), Forlì (n=409), Siena (n=276). The relation among lymphadenectomy and pN category was assessed by Kendall's partial rank-order correlation coefficient, controlling for depth of tumour invasion. A direct evaluation of the Will Rogers phenomenon was accomplished in the Verona series, by comparing the number of positive nodes actually observed with the number of positive nodes which would have been retrieved by a less extended lymphadenectomy (D1). The number of positive nodes increased remarkably with the enlargement of lymphadenectomy, especially in pT2 patients (from 2.2±3.9 in D1 to 3.9±5.0 in D3) and in pT3/pT4 patients (from 5.1±5.9 in D1 to 11.3±12.6 in D3). Non-parametric statistics highlighted a weak (Kendall's partial T=0.128) but significant (P<0.001) correlation between pN category and extension of lymphadenectomy. In the direct analysis of the Verona series, 22 patients out of 230 (9.6%) migrated to a lower pN tier when ignoring positive nodes retrieved from the second and third level. This percentage increased to 39.1% (90 out of 230) when adopting the TNM 87 classification. In conclusion stage migration is of minor importance in gastric cancer patients, staged according to the new pN classification

Topics: Molecular and Cellular Pathology
Publisher: Nature Publishing Group
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Provided by: PubMed Central

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  1. (1999). Classification of lymph nodes metastases in the carcinoma of the Stomach: comparison between the old and the new TNM systems.
  2. (1995). Surgical/Pathologic-stage migration confounds comparisons of gastric cancer survival rates between Japan and Western countries.
  3. (1997). TNM Classification of malignant tumours. 5th edition.

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