title: Comparison of the current AJCC-TNM numeric-based with a new anatomical location-based lymph node staging system for gastric cancer: A western experience.
abstract: BACKGROUND
  In gastric cancer, the current AJCC numeric-based lymph node staging does not provide information on the anatomical extent of the disease and lymphadenectomy. A new anatomical location-based node staging, proposed by Choi, has shown better prognostic performance, thus soliciting Western world validation.
  
  
  METHODS
  Data from 284 gastric cancers undergoing radical surgery at the Second University of Naples from 2000 to 2014 were reviewed. The lymph nodes were reclassified into three groups (lesser and greater curvature, and extraperigastric nodes); presence of any metastatic lymph node in a given group was considered positive, prompting a new N and TNM stage classification. Receiver-operating-characteristic (ROC) curves for censored survival data and bootstrap methods were used to compare the capability of the two models to predict tumor recurrence.
  
  
  RESULTS
  More than one third of node positive patients were reclassified into different N and TNM stages by the new system. Compared to the current staging system, the new classification significantly correlated with tumor recurrence rates and displayed improved indices of prognostic performance, such as the Bayesian information criterion and the Harrell C-index. Higher values at survival ROC analysis demonstrated a significantly better stratification of patients by the new system, mostly in the early phase of the follow-up, with a worse prognosis in more advanced new N stages, despite the same current N stage.
  
  
  CONCLUSIONS
  This study suggests that the anatomical location-based classification of lymph node metastasis may be an important tool for gastric cancer prognosis and should be considered for future revision of the TNM staging system.
authors.affiliation: Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Gennaro
authors.identifier: http://orcid.org/0000-0002-6897-0391
authors.initials: G
authors.lastname: Galizia
authors.affiliation: Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Lieto
authors.affiliation: Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Auricchio
authors.affiliation: Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Cardella
authors.affiliation: Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mabilia
authors.affiliation: Division of Medical Oncology, "F. Magrassi" Department of Clinical and Experimental Medicine and Surgery, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Diana
authors.affiliation: Division of Surgical Oncology, Department of Surgical Sciences, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellano
authors.affiliation: Division of Medical Oncology, "F. Magrassi" Department of Clinical and Experimental Medicine and Surgery, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Ferdinando
authors.initials: F
authors.lastname: De Vita
authors.affiliation: Division of Medical Oncology, "F. Magrassi" Department of Clinical and Experimental Medicine and Surgery, University of Campania 'Luigi Vanvitelli', School of Medicine, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Orditura
mesh_terms: D000368:Aged; D001499:Bayes Theorem; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012372:ROC Curve; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000473:pathology*; D016019:Survival Analysis