title: Validation of the new AJCC TNM staging system for gastric cancer in a large cohort of patients (n = 2,155): focus on the T category.
abstract: BACKGROUND
  The prognostic value of T subclassification in patients with gastric carcinoma has been just implemented in the new AJCC TNM staging system, which has reclassified T2a and T2b into T2 and T3 tumors, respectively. The aim of the present study was to validate the prognostic significance of the new T categorization within the frame of the latest TNM staging system.
  
  
  METHODS
  We retrospectively reviewed the records of 686 T2/T3 patients among 2155 subjects who underwent radical resection for gastric carcinoma at six Italian centers from 1988 through 2006.
  
  
  RESULTS
  Upon multivariate analysis, the new T categories, extent of lymph node dissection (D) and patient's age were retained by the survival model as independent prognostic factors. In particular, the death risk for patients with T3 tumors was higher than that of patients with T2 tumors (HR: 1.42, P = 0.005). Among the 686 patients previously classified as having T2 tumors, patients with T2 and T3 disease were 270 (39.4%) and 416 (60.6%), respectively. After a median follow-up of 55 months, the 5-year overall survival rates were 67.3% and 52.3% for patients with T2 and T3 tumors, respectively (P < 0.001). The survival advantage for the T2 as compared to T3 category was maintained even when N0 and N+ patients were separately considered (P = 0.0154 and P < 0.001, respectively).
  
  
  CONCLUSIONS
  Our data confirm the prognostic difference between the newly proposed T2 and T3 categories, which should be implemented in the routine clinical practice to improve risk stratification of patients with gastric cancer.
authors: Clinica Chirurgica II, Department of Oncological and Surgical Sciences, University of Padova, Padova, Italy. marchet@unipd.it
authors: A
authors: A
authors: Marchet
authors: S
authors: S
authors: Mocellin
authors: A
authors: A
authors: Ambrosi
authors: P
authors: P
authors: Morgagni
authors: G
authors: G
authors: Vittimberga
authors: F
authors: F
authors: Roviello
authors: D
authors: D
authors: Marrelli
authors: G
authors: G
authors: de Manzoni
authors: A
authors: A
authors: Minicozzi
authors: A
authors: A
authors: Coniglio
authors: G
authors: G
authors: Tiberio
authors: F
authors: F
authors: Pacelli
authors: F
authors: F
authors: Rosa
authors: D
authors: D
authors: Nitti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D011379:Prognosis; D013274:Stomach Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology*; D016019:Survival Analysis