title: Proposal of a Dukes-MAC-like staging system for gastric cancer.
abstract: The aim of this study was to present an epidemiological update regarding the classical prognostic parameters of gastric cancer (GC) in 3 countries from Eastern Europe and to suggest a modification of the pTNM staging system. In 333 consecutive cases which were diagnosed between 2003 and 2012 in 3 departments of pathology from Romania, Hungary, and Poland, the following parameters were analyzed: age and gender of patients, tumor localization, macroscopic and microscopic aspects including the degree of discohesivity, depth of tumor infiltration, and pTNM stage. From all of the studied parameters, the following proved to have independent prognostic value, indicating a lower survival rate: presence of distant metastases (p=0.001), lymph node positivity (p=0.0009), depth of tumor infiltration (p=0.04), age over 50 (p=0.02), proximally located tumors (p=0.03), and ulceroinfiltrative or diffusely infiltrative macroscopic aspect (p=0.0002). The pT2N1-3 staged cases showed a worse prognosis compared with the pT3N0 ones (p=0.02). Regardless of depth of invasion, the lymph node status remains the strongest indicator of the survival rate in GC. The pTN staging system should be adapted and a Dukes-MAC-like staging system should include the following groups: stage A1-T1N0, stage A2-T1N1-3, stage B1-T2N0, stage B2-T2N1-3, stage C1-T3N0, stage C2-T3N1-3, and stage D-T4N0-3. The grade of discohesivity/budding is not a prognostic factor in GC.
authors.affiliation: Department of Pathology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
authors.forename: Simona
authors.initials: S
authors.lastname: Gurzu
authors.affiliation: Department of Tumor Pathology, Hamamatsu University, Hamamatsu, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sugimura
authors.affiliation: Department of Pathology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Janina
authors.initials: J
authors.lastname: Orlowska
authors.affiliation: Department of Intensive Care, University of Medicine and Pharmacy, Tirgu Mures, Romania.
authors.forename: Janos
authors.initials: J
authors.lastname: Szederjesi
authors.affiliation: Department of Molecular Pathology, National Institute of Oncology, Budapest, Hungary.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Szentirmay
authors.affiliation: Department of Surgery, University of Medicine and Pharmacy, Tirgu Mures, Romania.
authors.forename: Tivadar
authors.initials: T
authors.lastname: Bara
authors.affiliation: Department of Surgery, University of Medicine and Pharmacy, Tirgu Mures, Romania.
authors.forename: Tivadar
authors.initials: T
authors.lastname: Bara
authors.affiliation: Department of Pathology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
authors.forename: Ananmaria
authors.initials: A
authors.lastname: Fetyko
authors.affiliation: Department of Pathology, University of Medicine and Pharmacy, Tirgu Mures, Romania.
authors.forename: Ioan
authors.initials: I
authors.lastname: Jung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D005843:Geography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D013274:Stomach Neoplasms / Q000473:pathology*; D016019:Survival Analysis; D055815:Young Adult
keywords: Cancer; Carcinoma; Interdisciplinary Studies; Stomach