title: Improving the AJCC/TNM classification for use in early gastric cancer.
abstract: OBJECTIVE
  The current TNM classification is still unsatisfactory for collecting all the prognostic information from the clinical presentation of early gastric cancer: "T" is limited to two levels, the classes of "N" are still wide and "M" is generally absent.
  
  
  METHODS
  This study involved 99 patients who underwent radical gastric resection for early gastric cancer. Clinical and histological parameters were prognostically analyzed for both observed and relative survival. Univariate and multivariate analyses were applied to the proportional hazards model.
  
  
  RESULTS
  Number of metastatic lymph nodes and measure of the largest diameter of the tumor were the only independent prognosticators of observed and relative survival. Their similar relative hazards allowed an additive use of them in the N class. Two cut-off values of this composite clinical parameter are proposed for a good discrimination of the relative survival.
  
  
  CONCLUSIONS
  The number of metastatic lymph nodes is the cornerstone of the current TNM system and was confirmed as adequate. The possibility of adding tumor size to the number of the involved lymph nodes improves and amplifies the prognostic ability, which is presently limited by the rarity of lymph node involvement and the small number of the lymph nodes usually involved.
authors.affiliation: Medicina Interna e Gastroenterologia, Università di Pavia, Fondazione IRCCS Policlinico S. Matteo, P.le Golgi n° 2, 27100, Pavia, Italy. gobbipg@smatteo.pv.it
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Gobbi
authors.forename: Lara
authors.initials: L
authors.lastname: Villano
authors.forename: Donatella
authors.initials: D
authors.lastname: Pozzoli
authors.forename: Manuela
authors.initials: M
authors.lastname: Bergonzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vanoli
authors.forename: Francesca
authors.initials: F
authors.lastname: Tava
authors.forename: Paolo
authors.initials: P
authors.lastname: Dionigi
authors.forename: Gino Roberto
authors.initials: GR
authors.lastname: Corazza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult