Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data

Wei Wang; Yu-Jie Yang; Ri-Hong Zhang; Jing-Yu Deng; Zhe Sun; Sharvesh Raj Seeruttun; Zhen-Ning Wang; Hui-Mian Xu; Han Liang; Zhi-Wei Zhou

doi:10.1186/s40779-022-00375-2

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Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data

RESEARCH | Updated：2023-02-28

- Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data
- Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data
- 解放军医学杂志（英文版） 2022年9卷第5期页码：565-575
- Affiliations：
  
  1.Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
  2.State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
  3.Department of Gastric Cancer Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300000, China
  4.Department of Surgical Oncology, the First Hospital of China Medical University, Shenyang 110000, China
- Author bio：
  
  * josieon826@sina.cn;
  xuhuimian@126.com;
  tjlianghan@126.com;
  zhouzhw@sysucc.org.cn
- Funds：
  
  the National Natural Science Foundation of China(81802451);the China Postdoctoral Science Foundation(2017M622879);the Natural Science Foundation of Guangdong Province(2114050002182;2018A030313827;2021A1515011327);the Young Teacher Training Program of Sun Yat-sen University(19ykpy172)
- DOI：10.1186/s40779-022-00375-2
  中图分类号：
- 纸质出版：2022-10
- Accepted：
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Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data[J]. 解放军医学杂志（英文版）, 2022,9(5):565-575.

Wang W, Yang YJ, Zhang RH, Deng JY, Sun Z, Seeruttun SR, et al. Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data. Mil Med Res. 2022;9(1):15.
Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data[J]. 解放军医学杂志（英文版）, 2022,9(5):565-575. DOI： 10.1186/s40779-022-00375-2.

Wang W, Yang YJ, Zhang RH, Deng JY, Sun Z, Seeruttun SR, et al. Standardizing the classification of gastric cancer patients with limited and adequate number of retrieved lymph nodes: an externally validated approach using real-world data. Mil Med Res. 2022;9(1):15. DOI： 10.1186/s40779-022-00375-2.

摘要

Abstract

Background:

Currently

there is no formal consensus regarding a standard classification for gastric cancer (GC) patients with <16 retrieved lymph nodes (rLNs). Here

this study aimed to validate a practical lymph node (LN) staging strategy to homogenize the nodal classification of GC cohorts comprising of both <16 (Limited set) and ≥16 (Adequate set) rLNs.

Methods:

All patients in this study underwent R0 gastrectomy. The overall survival (OS) difference between the Limited and Adequate sets from a large Chinese multicenter dataset was analyzed. Using the 8th American Joint Committee on Cancer (AJCC) pathological nodal classification (pN) for GC as base

a modified nodal classification (N’) resembling similar analogy as the 8th AJCC pN classification was developed. The performance of the proposed and 8th AJCC GC subgroups was compared and validated using the Surveillance

Epidemiology

and End Results (SEER) dataset comprising of 10

208 multi-ethnic GC cases.

Results:

Significant difference in OS between the Limited and Adequate sets (corresponding N0–N3a) using the 8th AJCC system was observed but the OS of N0

limited

. N1

adequate

limited

. N2

adequate

limited

. N3a

adequate

and N3a

limited

. N3b

adequate

subgroups was almost similar in the Chinese dataset. Therefore

we formulated an N’ classification whereby only the nodal subgroups of the Limited set

except for pT1N0M0 cases as they underwent less extensive surgeries (D1 or D1 + gastrectomy)

were re-classified to one higher nodal subgroup

while those of the Adequate set remained unchanged (N’0=N0

adequate

+pT1N0M0

limited

N’1=N1

adequate

+N0

limited (excluding pT1N0M0limited)

N’2=N2

adequate

+N1

limited

N’3a=N3a

adequate

+N2

limited

and N’3b=N3b

adequate

+N3a

limited

). This N’ classification demonstrated less heterogeneity in OS between the Limited and Adequate subgroups. Further analyses demonstrated superior statistical performance of the pTN’M system over the 8th AJCC edition and was successfully validated using the SEER dataset.

Conclusions:

The proposed nodal staging strategy was successfully validated in large multi-ethnic GC datasets and represents a practical approach for homogenizing the classification of GC cohorts comprising of patients with <16 and ≥16 rLNs.

关键词

Keywords

references

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