title: Validating the prognostic and discriminating value of the TNM-classification for gastric cancer - a critical appraisal.
abstract: OBJECTIVE
  We investigated the effect of the new tumour-, node-, metastasis- (TNM) classification on predicting and discriminating gastric cancer patient prognosis using the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program.
  
  
  METHODS
  From the SEER-database we retrieved gastric cancer patients with a primary adenocarcinoma, of Caucasian or Asian ethnicity and without distant metastases (M0). The pTNM-stage was determined according to the 7th edition of the union internationale contre le cancer (UICC) guidelines.
  
  
  RESULTS
  Spanning the period 2004-2010, 6136 patients fulfilled all inclusion criteria including 3424 (55.8%) men, 2712 (44.2%) women, 4629 (75.4%) Caucasian and 1507 (24.6%) Asian patients. 1524 (24.8%) patients underwent total gastrectomy and 4612 (75.2%) non-total gastrectomy. Only in 41.2% of the patients were >15 lymph nodes resected. 1857 (31.0%) patients received radiotherapy. Patient survival depended on ethnicity, type of surgery and radiotherapy. The discriminating value of the UICC-stage grouping could not be validated for Caucasian patients with >15 lymph nodes resected and who had not received radiotherapy: stage groups IIB, IIIA, IIIB and IIIC showed substantial overlap in survival ranges. In addition, the tumour specific survival of the different T-/N-combinations was significantly different in stage groups IIIB and IIIC, respectively.
  
  
  CONCLUSIONS
  Our retrospective analysis of the SEER-database does not validate the discriminating value of stage grouping of the 7th edition of the UICC-stage grouping. A revision should be considered and more reliable prognostic biomarkers are urgently needed.
authors: Department of Pathology, Christian-Albrechts-University, Kiel, Germany. Electronic address: christoph.roecken@uk-sh.de.
authors: C
authors: C
authors: Röcken
authors: Department of Pathology, Christian-Albrechts-University, Kiel, Germany.
authors: H-M
authors: HM
authors: Behrens
mesh_terms: D000230:Adenocarcinoma / Q000208:ethnology / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D000368:Aged; D016002:Discriminant Analysis; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018426:SEER Program; D013274:Stomach Neoplasms / Q000208:ethnology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Gastric cancer; Prognosis; Stage grouping; TNM-classification