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Incorporation of extranodal metastasis of gastric carcinoma into the 7th edition UICC TNM staging system.

Wang W, Li Y, Zhang Y, Yuan X, Xu D, Guan Y, Feng X, Chen Y, Sun X, Li W, Zhan Y, Zhou Z - PLoS ONE (2011)

Bottom Line: Survival of patients with EM1 was found almost comparable to that of N3 stage (P = 0.437).By using the linear trend X(2), likelihood ratio X(2), and Akaike information criterion (AIC) test, EM1 treated as N3 stage and EM2 treated as M1 stage performed higher linear trend X(2) scores, likelihood ratio X(2) scores, and lower AIC value than the 7(th) edition UICC TNM staging system, which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability, and monotonicity of gradients.EMs might be classified based on their number and prognostic information and should incorporate into the TNM staging system.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: To assess the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma and establish an optimal classification in the staging system.

Methodology/principal findings: A total of 1343 patients with gastric carcinoma who underwent surgical resection were recruited to determine the frequency and prognostic significance of EMs. EMs were divided into two groups (EM1 and EM2) and then incorporated into the 7(th) edition UICC TNM staging system. EMs was detected in 179 (13.3%) of 1343 patients who underwent radical resection. Multivariate analysis identified EMs as an independent prognostic factor (HR = 1.412, 95%CI = 1.151-1.731, P<0.001). After curative operation, the overall survival rate were worse in patients with ≥3 cases of EM (EM2) than those with the number of 1 and 2 cases (EM1) (P<0.001). Survival of patients with EM1 was found almost comparable to that of N3 stage (P = 0.437). Survival of patients with EM2 showed similar to that of stage IV patients (P = 0.896). By using the linear trend X(2), likelihood ratio X(2), and Akaike information criterion (AIC) test, EM1 treated as N3 stage and EM2 treated as M1 stage performed higher linear trend X(2) scores, likelihood ratio X(2) scores, and lower AIC value than the 7(th) edition UICC TNM staging system, which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability, and monotonicity of gradients.

Conclusions/significance: EMs might be classified based on their number and prognostic information and should incorporate into the TNM staging system.

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Related in: MedlinePlus

Prognostic significance of extranodal metastasis (EM) on overall survival rate of the gastric carcinoma patients underwent curative surgery.2A: A positive EM was significantly associated with a shorter survival time (P<0.001). 2B: Overall survival curves of gastric carcinoma patients stratified by EM number (0, 1, 2, ≥3), (P<0.001, P = 0.337, P = 0.001, respectively).
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pone-0019557-g002: Prognostic significance of extranodal metastasis (EM) on overall survival rate of the gastric carcinoma patients underwent curative surgery.2A: A positive EM was significantly associated with a shorter survival time (P<0.001). 2B: Overall survival curves of gastric carcinoma patients stratified by EM number (0, 1, 2, ≥3), (P<0.001, P = 0.337, P = 0.001, respectively).

Mentions: Positive EMs were significantly associated with a shorter survival time (P<0.001) (Fig. 2A). Analysis of patients grouped according to the number of EMs revealed that patients with EMs ≥3 had an even worse postoperative survival than that of patients with the number of EMs less than 3. The 5-year survival rate of patients with the number of EMs as 1, 2, and ≥3 were 35.2%, 27.6%, and 6.8% (P = 0.337 and 0.001, respectively) (Fig. 2B).


Incorporation of extranodal metastasis of gastric carcinoma into the 7th edition UICC TNM staging system.

Wang W, Li Y, Zhang Y, Yuan X, Xu D, Guan Y, Feng X, Chen Y, Sun X, Li W, Zhan Y, Zhou Z - PLoS ONE (2011)

Prognostic significance of extranodal metastasis (EM) on overall survival rate of the gastric carcinoma patients underwent curative surgery.2A: A positive EM was significantly associated with a shorter survival time (P<0.001). 2B: Overall survival curves of gastric carcinoma patients stratified by EM number (0, 1, 2, ≥3), (P<0.001, P = 0.337, P = 0.001, respectively).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3113802&req=5

pone-0019557-g002: Prognostic significance of extranodal metastasis (EM) on overall survival rate of the gastric carcinoma patients underwent curative surgery.2A: A positive EM was significantly associated with a shorter survival time (P<0.001). 2B: Overall survival curves of gastric carcinoma patients stratified by EM number (0, 1, 2, ≥3), (P<0.001, P = 0.337, P = 0.001, respectively).
Mentions: Positive EMs were significantly associated with a shorter survival time (P<0.001) (Fig. 2A). Analysis of patients grouped according to the number of EMs revealed that patients with EMs ≥3 had an even worse postoperative survival than that of patients with the number of EMs less than 3. The 5-year survival rate of patients with the number of EMs as 1, 2, and ≥3 were 35.2%, 27.6%, and 6.8% (P = 0.337 and 0.001, respectively) (Fig. 2B).

Bottom Line: Survival of patients with EM1 was found almost comparable to that of N3 stage (P = 0.437).By using the linear trend X(2), likelihood ratio X(2), and Akaike information criterion (AIC) test, EM1 treated as N3 stage and EM2 treated as M1 stage performed higher linear trend X(2) scores, likelihood ratio X(2) scores, and lower AIC value than the 7(th) edition UICC TNM staging system, which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability, and monotonicity of gradients.EMs might be classified based on their number and prognostic information and should incorporate into the TNM staging system.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: To assess the clinical significance and prognostic impact of extranodal metastasis (EM) in gastric carcinoma and establish an optimal classification in the staging system.

Methodology/principal findings: A total of 1343 patients with gastric carcinoma who underwent surgical resection were recruited to determine the frequency and prognostic significance of EMs. EMs were divided into two groups (EM1 and EM2) and then incorporated into the 7(th) edition UICC TNM staging system. EMs was detected in 179 (13.3%) of 1343 patients who underwent radical resection. Multivariate analysis identified EMs as an independent prognostic factor (HR = 1.412, 95%CI = 1.151-1.731, P<0.001). After curative operation, the overall survival rate were worse in patients with ≥3 cases of EM (EM2) than those with the number of 1 and 2 cases (EM1) (P<0.001). Survival of patients with EM1 was found almost comparable to that of N3 stage (P = 0.437). Survival of patients with EM2 showed similar to that of stage IV patients (P = 0.896). By using the linear trend X(2), likelihood ratio X(2), and Akaike information criterion (AIC) test, EM1 treated as N3 stage and EM2 treated as M1 stage performed higher linear trend X(2) scores, likelihood ratio X(2) scores, and lower AIC value than the 7(th) edition UICC TNM staging system, which represented the optimum prognostic stratification, together with better homogeneity, discriminatory ability, and monotonicity of gradients.

Conclusions/significance: EMs might be classified based on their number and prognostic information and should incorporate into the TNM staging system.

Show MeSH
Related in: MedlinePlus