ajcc 7 e g c 文h3rdfr1i.pptVIP

Serosal importance * paper * paper * The current TNM staging reflects the anatomical extent of the tumor. But we know certain non anatomical factors, such as cell type, tumor grading and lympovascular permeation affect prognosis. So, should the future TNM staging include these non anatomical factors? Need studies to confirm whether they are independent factor using multivariate analysis * Qn: OGJ staging- in previous 6th ed, there was no statement on whether it shd be staged under eso or stomach, Stage grouping * Could appear as a result of optimism towards new therapeutic strategies for locally advanced disease * Ca Stomach – N stage In 1997, UICC/AJCC used the number of met LN in N staging for a more uniform and comparable system for western and Japanese 5th Ed AJCC Staging Ca Stomach – N stage 5th AJCC N staging was more simple, reproducible and sensitive in the prognostic evaluation than the JCGC N staging Cancer 2000;88:1796-800 Br J Surg 1994;81:414-4 Surg Gynecol Obstet 1990;170:488-94 Ai Zheng 2005;24:596-9 Arch Surg 1992;127:290-4 Retained in 6th Ed Ca Stomach – N stage 5th/6th Ed N staging was criticized for inappropriate cut-off of the N number, especially in N1, for homogeneity and prediction of prognosis Ann Surg Oncol 2009;16:61-7 J Surg Oncol 2006;94:274-80 Dig Surg 2003;20:148-53 Gut 1996;38:525-7 J Clin Oncol 1993;11:1894-900 Chin Med J 2007;120:2268-70 Ca Stomach – N stage Nx Regional LN cannot be assessed N0 No regional LN mets N1 Mets in 1-6 regional LN N2 Mets in 7-15 regional LN N3 Mets in 15 regional LN AJCC 6th Ed Nx Regional LN cannot be assessed N0 No regional LN mets N1 Mets in 1-2 regional LN N2 Mets in 3-6 regional LN N3a Mets in 7-15 regional LN N3b Mets in ≥ 16 regional LN AJCC 6th Ed AJCC 7th Ed Univariate analysis: 7th Ed N stage, 5th/6th Ed N stage and JCGC N stage were associated with overall survival Multivariate analysis, only 7th Ed N stage is an independent factor Using case control matched fashion, 7th Ed