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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 among 103 cases of stage III patients with EM1 before and after consideration of EM1.4A: Patients with EM1 had a comparable overall survival curves among each substage when EM1 was ignored (P = 0.991). 4B: Patients with EM1 had a distinguishable overall survival curves among each substage when with the consideration of EM1 as N3 stage (P = 0.023).
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pone-0019557-g004: Comparison of survival curves among 103 cases of stage III patients with EM1 before and after consideration of EM1.4A: Patients with EM1 had a comparable overall survival curves among each substage when EM1 was ignored (P = 0.991). 4B: Patients with EM1 had a distinguishable overall survival curves among each substage when with the consideration of EM1 as N3 stage (P = 0.023).

Mentions: Furthermore, we realized that 78.8% (141 of 179) of the EMs was mainly found in stage III patients, with 103 cases of EM1 and 38 cases of EM2. In order to investigate the incidence and influence of EM1 in stage III patients, we analyzed the survival outcomes with and without consideration of EM1 as N3. Without consideration of EM1, the distribution of stage III was 27 cases of stage IIIA, 37 cases of stage IIIB, and 39 cases of stage IIIC patients. The survival curves were shown in Fig. 4A, in which the survival difference in each substage was confused (P = 0.991). When we treated the EM1 as N3 patients, the distribution of stage III was changed as 1 case of stage IIIA, 27 cases of stage IIIB, and 75 cases of stage IIIC patients. The survival curves were shown discriminatory in each substage (P = 0.023) (Fig. 4B).


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 among 103 cases of stage III patients with EM1 before and after consideration of EM1.4A: Patients with EM1 had a comparable overall survival curves among each substage when EM1 was ignored (P = 0.991). 4B: Patients with EM1 had a distinguishable overall survival curves among each substage when with the consideration of EM1 as N3 stage (P = 0.023).
© Copyright Policy
Related In: Results  -  Collection

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

pone-0019557-g004: Comparison of survival curves among 103 cases of stage III patients with EM1 before and after consideration of EM1.4A: Patients with EM1 had a comparable overall survival curves among each substage when EM1 was ignored (P = 0.991). 4B: Patients with EM1 had a distinguishable overall survival curves among each substage when with the consideration of EM1 as N3 stage (P = 0.023).
Mentions: Furthermore, we realized that 78.8% (141 of 179) of the EMs was mainly found in stage III patients, with 103 cases of EM1 and 38 cases of EM2. In order to investigate the incidence and influence of EM1 in stage III patients, we analyzed the survival outcomes with and without consideration of EM1 as N3. Without consideration of EM1, the distribution of stage III was 27 cases of stage IIIA, 37 cases of stage IIIB, and 39 cases of stage IIIC patients. The survival curves were shown in Fig. 4A, in which the survival difference in each substage was confused (P = 0.991). When we treated the EM1 as N3 patients, the distribution of stage III was changed as 1 case of stage IIIA, 27 cases of stage IIIB, and 75 cases of stage IIIC patients. The survival curves were shown discriminatory in each substage (P = 0.023) (Fig. 4B).

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