A Comparison between the 4 th and 5 th Editions of the UICC Stage Classification of the Gastric Cancer with Special Emphasis

Yang, Joon Ho; Park, Seong Heum; Park, Sei Hyeog; Kim, Chong Heung; Choi, Kyung Woo

Abstract

PURPOSE
In the new 5th edition of the UICC-TNM stage classification for gastric cancer, there were substantial changes for the N classification by accepting the convenience of the quantitative system. This study is intended to evaluate the efficacy of the new edition.
MATERIALS AND METHODS
The stages and nodal status were retrospectively reclassified according to the 5th edition in 399 patients with gastric cancer who were operated at the NMC and they were compared with the result classified by the 4th edition.
RESULTS
Each stage system showed a significant difference in respect to the survival among subgroups of patients. Lymph nodes metastasis by both classification systems also showed a significant difference in respect to the survival among the subgroups. Five-year survival rate decreased significantly in relation to numbers of metastatic lymph nodes. Multivariate analysis revealed that new staging system was one of the highly significant prognostic factor. Patients with metastatic deposits in the regional lymph nodes in the hepatoduodenal ligament, classified as distant nodes in the 4th edition, had worse survival than those without. There was no significant survival difference between the patients with N3 and those with distant node metastasis in the 5th edition.
CONCLUSION
Although the new UICC-TNM classification seemed to need further classification by comparative studies, it might be a more convenient staging system with an ability to identify subgroups with different survival. But, it still has some controversies.