ArticleCancer communications (London, England)2019
A homogenized approach to classify advanced gastric cancer patients with limited and adequate number of pathologically examined lymph nodes.
Article in Cancer communications (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 18 citations in OpenAlex.
- Safety and efficacy of indocyanine green-guided laparoscopic lymphadenectomy for locally advanced gastric cancer: The CLASS-11 clinical trials.Cell reports. Medicine · 2025Trial
- Deep learning-based prediction of lymph node metastasis and occult tumor cells in gastric cancer using histopathological images: a retrospective study.British journal of cancer · 2026Article
- A prognostic nomogram based on log odds of positive lymph nodes to predict survival in gastric cancer patients with neoadjuvant chemotherapy: a large population-based cohort study and external validation.Journal of gastrointestinal oncology · 2026Article
- Proposal for a new N-stage classification system for intrahepatic cholangiocarcinoma.Frontiers in oncology · 2023Article
- Revisiting the 8th AJCC system for gastric cancer: A review on validations, nomograms, lymph nodes impact, and proposed modifications.Annals of medicine and surgery (2012) · 2022Review
- Cancer cells invasion to the gastric bare area adipose tissue: a poor prognostic predictor for gastric cancer.World journal of surgical oncology · 2020Article
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8 authors at 2 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThe prognosis of gastric cancer patients with a limited number of pathologically examined lymph nodes (eLN, < 16) is dismal compared to those with adequately eLN (≥ 16), yet they are still classified within the same subgroups using the American Joint Committee on Cancer (AJCC) staging system. We aimed at formulating an easy-to-adopt and clinically reliable stratification approach to homogenize the classification for these two categories of patients.
methodsPatients staged according to the 8th AJCC pathological nodal (N) and tumor-node-metastasis (TNM) classification were stratified into a Limited and Adequate eLN cohort based on their number of pathologically examined LNs. The statistical differences between the 5-year overall survival (OS) rates of both cohorts were determined and based on which, patients from the Limited eLN cohort were re-classified to a proposed modified nodal (N') and TNM (TN'M) classification, by matching their survival rates with those of the Adequate eLN cohort. The prognostic performance of the N' and TN'M classification was then compared to a formulated lymph-node-ratio-based nodal classification, in addition to the 8th AJCC N and TNM classification.
resultsSignificant heterogeneous differences in 5-year OS between patients from the Limited and Adequate eLN cohort of the same nodal subgroups were identified (all P < 0.001). However, no significant differences in 5-year OS were observed between the subgroups N0, N1, N2, and N3a of the Limited eLN cohort when compared with N1, N2, N3a, and N3b from the Adequate eLN cohort, respectively (P = 0.853, 0.476, 0.114, and 0.230, respectively). A novel approach was formulated in which only patients from the Limited eLN cohort were re-classified to one higher nodal subgroup, denoted as the N' classification. This re-classification demonstrated superior stratifying and prognostic ability as compared to the 8th AJCC N and lymph-node-ratio classification (Akaike information criterion values [AIC]: 12,276 vs. 12,358 vs. 12,283, respectively). The TN'M classification also demonstrated superior prognostic ability as compared to the 8th AJCC TNM classification (AIC value: 12,252 vs. 12,312).
conclusionThe proposed lymph node classification approach provides a clinically practical and reliable technique to homogeneously classify cohorts of gastric cancer patients with limited and adequate number of pathologically examined lymph nodes.
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