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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

Comparison of survival curves between EMs and the T, N, M stages.3A: Overall survival curves showed different outcomes among patients with T4a, EM1 and T4b (P = 0.002 and 0.016, respectively). 3B: Overall survival of patients with EM1 was worse than those of the N2 stage and was comparable to those of the N3 stage (P = 0.039 and 0.437, respectively). 3C: Patients with EM2 had a comparable overall survival with those of the M1 stage (P = 0.896).
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pone-0019557-g003: Comparison of survival curves between EMs and the T, N, M stages.3A: Overall survival curves showed different outcomes among patients with T4a, EM1 and T4b (P = 0.002 and 0.016, respectively). 3B: Overall survival of patients with EM1 was worse than those of the N2 stage and was comparable to those of the N3 stage (P = 0.039 and 0.437, respectively). 3C: Patients with EM2 had a comparable overall survival with those of the M1 stage (P = 0.896).

Mentions: First, we compared the survival curve between patients with EM1 and T stage. The Kaplan-Meier plots showed a good discriminatory ability between patients with pT4a stage and patients with EM1 (5-year survival rate 48.8% vs. 32.6%, P = 0.002), also between patients with EM1 and those with T4b stage (5-year survival rate 32.6% vs. 23.4%, P = 0.016) (Fig. 3A). Secondly, when we compared the survival outcomes between patients with EM1 and N stage, the overall survival rate of patients with EM1 was found almost comparable to that of patients with N3 stage (5-year survival rate 31.3% vs. 32.6%, P = 0.437) and was found significant worse than that of patients with N2 stage (5-year survival rate 32.6% vs. 44.1%, P = 0.039) (Fig. 3B). Thirdly, when we investigated the possible origination of EM2 from peritoneal seeding, we found that the overall survival rate of patients with EM2 showed similar to that of aforementioned 106 cases of stage IV patients. The 5-year survival rate was 6.8% and 5.6%, respectively (P = 0.896) (Fig. 3C).


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)

Comparison of survival curves between EMs and the T, N, M stages.3A: Overall survival curves showed different outcomes among patients with T4a, EM1 and T4b (P = 0.002 and 0.016, respectively). 3B: Overall survival of patients with EM1 was worse than those of the N2 stage and was comparable to those of the N3 stage (P = 0.039 and 0.437, respectively). 3C: Patients with EM2 had a comparable overall survival with those of the M1 stage (P = 0.896).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0019557-g003: Comparison of survival curves between EMs and the T, N, M stages.3A: Overall survival curves showed different outcomes among patients with T4a, EM1 and T4b (P = 0.002 and 0.016, respectively). 3B: Overall survival of patients with EM1 was worse than those of the N2 stage and was comparable to those of the N3 stage (P = 0.039 and 0.437, respectively). 3C: Patients with EM2 had a comparable overall survival with those of the M1 stage (P = 0.896).
Mentions: First, we compared the survival curve between patients with EM1 and T stage. The Kaplan-Meier plots showed a good discriminatory ability between patients with pT4a stage and patients with EM1 (5-year survival rate 48.8% vs. 32.6%, P = 0.002), also between patients with EM1 and those with T4b stage (5-year survival rate 32.6% vs. 23.4%, P = 0.016) (Fig. 3A). Secondly, when we compared the survival outcomes between patients with EM1 and N stage, the overall survival rate of patients with EM1 was found almost comparable to that of patients with N3 stage (5-year survival rate 31.3% vs. 32.6%, P = 0.437) and was found significant worse than that of patients with N2 stage (5-year survival rate 32.6% vs. 44.1%, P = 0.039) (Fig. 3B). Thirdly, when we investigated the possible origination of EM2 from peritoneal seeding, we found that the overall survival rate of patients with EM2 showed similar to that of aforementioned 106 cases of stage IV patients. The 5-year survival rate was 6.8% and 5.6%, respectively (P = 0.896) (Fig. 3C).

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