• Journal of Gastric Cancer
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• 제21권3호
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• pp.236-245
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• 2021

Purpose: The numeric N stage has replaced the topographic N stage in the current tumor node metastasis (TNM) staging in gastric carcinoma. However, the usefulness of the topographic N stage in the current TNM staging system is uncertain. We aimed to investigate the prognostic value of the topographic N stage in the current TNM staging system. Materials and Methods: We reviewed the data of 3350 patients with gastric cancer who underwent curative gastrectomy. The anatomic regions of the metastatic lymph nodes (MLNs) were classified into 2 groups: perigastric and extra-perigastric. The prognostic value of the anatomic region was analyzed using a multivariate prognostic model with adjustments for the TNM stage. Results: In patients with lymph node metastasis, extra-perigastric metastasis demonstrated significantly worse survival than perigastric metastasis alone (5-year survival rate, 39.6% vs. 73.1%, respectively, P<0.001). Extra-perigastric metastasis demonstrated significantly worse survival within the same pN stage; the multivariate analysis indicated that extra-perigastric metastasis was an independent poor prognostic factor (hazard ratio=1.33; 95% confidence interval=1.01-1.75). The anatomic region of the MLNs improved the goodness-of-fit (likelihood ratio statistics, 4.57; P=0.033) of the prognostic model using the TNM stage. Conclusions: The anatomic region of MLNs has an independent prognostic value in the numeric N stage in the current TNM staging of gastric carcinoma.

• Tuberculosis and Respiratory Diseases
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• 제45권2호
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• pp.322-332
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• 1998

연구배경: 폐암환자에 있어서 병기판정은 적절한 치료방침과 환자의 예후를 예측하기 위해 필요하다. 소세포폐암은 진단시 광범위한 종격동침범이 있거나 전신적으로 전이된 경우가 많아 VALG이 제시한 two staging system이 주로 사용되어져왔다. 그러나 이러한 병기분류법은 환자의 예후 변별력에 한계가 있을 뿐 아니라 최근에는 완치 가능성이 높은 환자들을 대상으로 근치적절제술과 항암화학요법의 병용치료와 같은 보다 적극적인 치료들이 시도됨에 따라 균일하고 세분화된 병기분류의 필요성이 대두되고 있다. 저자들은 소세포폐암을 비소세포폐암과 같이 I, II, IIIa, IIIb 및 IV로 세분화되어 예후를 비교함으로써 소세포폐암의 경우에도 TNM 병기가 예후인자로서의 가치가 있는 지를 조사하였다. 대상 및 방법: 1989년 1월부터 1996년 12월까지 경북대학교 병원에서 소세포폐암으로 진단된 환자 166명 가운데 TNM 병기분류가 가능하였던 147명을 대상으로 하였으며, TNM 병기는 1997년에 새로이 개정된 International staging system에 의거하여 분류하였다. 환자의 생존여부는 환자기록부와 전화 및 우편조회로 조사하였으며 생존기간은 Kaplan-Meier method를 이용하여 산출하였고 생존기간의 차이는 log-rank test를 이용하여 비교하였다. 결 과: 전체대상환자 147예의 TNM 병기에 따른 중앙생존기간은 I/II기 18.5개월, IIIa기 11.3개월, IIIb가 9.4개월, 그리고 IV기가 5.4개월이었으며, 1년 및 2년 생존율은 I/II기의 경우 75% 와 37.5%, IIIa기는 46.7% 와 25.0%, IIIb기는 34.3% 와 11.3%, 그리고 IV기는 2.6%와 0%로 병기에 따라 유의한 차이가 있었다 (p<0.001). 2회 이상의 항암화학요법을 받은 84예의 TNM 병기에 따른 중앙생존기간은 I/II기 18.5개월, IIIa기 16.0개월, IIIb기 12.2개월, 그리고 병기 IV기 7.4개월이었으며, 1년 및 2년 생존율은 I/II기는 75%와 37.5%, IIIa기는 58.3%와 31.3%, IIIb기는 51.7%와 13.53%, 그리고 IV기는 3.8%와 0%로 병기에 따라 유의한 차이가 있었다(p<0.001). 병기에 따른 중앙생존기간과 생존율은 I-IIIb기는 IV 기와 유의한 차이가 있었고, 병기 I/II는 IIIa기와는 유의한 차이는 없었으나 IIIb기와는 유의한 차이가 있었으며, 병기 IIIa는 IIIb기에 비해 중앙생존기간 및 2년 생존율이 높았으나 통계학적으로 유의한 차이는 없었다. I-IIIb에서 T 병기와 N병기에 따른 예후는 전체환자와 2회 이상 항암화학요법을 받은 환자모두에서 T1-2와 T3와 T4에 비해 양호하였으며 T3와 T4는 차이가 없었고, N2는 N3에 비해 중앙 생존기간과 2년 생존율이 높았으나 통계학적 유의성은 없었다. 결 론: 이상의 결과로 소세포폐암의 경우에도 TNM 병가분류가 예후를 예측할 수 있는 인자로 생각되며, 제한기의 환자들만을 대상으로 하는 전향적인 연구는 환자들을 TNM 병기를 고려하여 환자들을 보다 세분화하는 것이 좋을 것 같다. 그러나 TNM 병기분류가 임상에서 적용되기 위해서는 보다 많은 환자들을 대상으로 한 연구가 필요할 것으로 생각된다.

• Journal of Gastric Cancer
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• 제18권2호
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• pp.142-151
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• 2018

Purpose: The modification of the cancer classification system aimed to improve the classical anatomy-based tumor, node, metastasis (TNM) staging by considering tumor biology, which is associated with patient prognosis, because such information provides additional precision and flexibility. Materials and Methods: We previously developed an mRNA expression-based single patient classifier (SPC) algorithm that could predict the prognosis of patients with stage II/III gastric cancer. We also validated its utilization in clinical settings. The prognostic single patient classifier (pSPC) differentiates based on 3 prognostic groups (low-, intermediate-, and high-risk), and these groups were considered as independent prognostic factors along with TNM stages. We evaluated whether the modified TNM staging system based on the pSPC has a better prognostic performance than the TNM 8th edition staging system. The data of 652 patients who underwent gastrectomy with curative intent for gastric cancer between 2000 and 2004 were evaluated. Furthermore, 2 other cohorts (n=307 and 625) from a previous study were assessed. Thus, 1,584 patients were included in the analysis. To modify the TNM staging system, one-grade down-staging was applied to low-risk patients according to the pSPC in the TNM 8th edition staging system; for intermediate- and high-risk groups, the modified TNM and TNM 8th edition staging systems were identical. Results: Among the 1,584 patients, 187 (11.8%), 664 (41.9%), and 733 (46.3%) were classified into the low-, intermediate-, and high-risk groups, respectively, according to the pSPC. pSPC prognoses and survival curves of the overall population were well stratified, and the TNM stage-adjusted hazard ratios of the intermediate- and high-risk groups were 1.96 (95% confidence interval [CI], 1.41-2.72; P<0.001) and 2.54 (95% CI, 1.84-3.50; P<0.001), respectively. Using Harrell's C-index, the prognostic performance of the modified TNM system was evaluated, and the results showed that its prognostic performance was better than that of the TNM 8th edition staging system in terms of overall survival (0.635 vs. 0.620, P<0.001). Conclusions: The pSPC-modified TNM staging is an alternative staging system for stage II/III gastric cancer.

• Journal of Gastric Cancer
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• 제20권3호
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• pp.233-244
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• 2020

Purpose: For unresectable or initially metastatic gastric cancer, conversion surgery (CVS), after systemic chemotherapy, has received attention as a treatment strategy. This study evaluated the prognostic value of ypTNM stage and the oncologic outcomes in patients receiving CVS. Materials and Methods: A retrospective review of clinicopathologic findings and oncologic outcomes of 116 patients who underwent CVS with curative intent, after combination chemotherapy, between January 2000 and December 2015, has been reported here. Results: Twenty-six patients (22.4%) underwent combined resection of another organ and 12 patients received para-aortic lymphadenectomy (10.3%). Pathologic complete remission (CR) was confirmed in 11 cases (9.5%). The median overall survival (OS) and disease-free survival (DFS) times were 35.0 and 21.3 months, respectively. In multivariate analysis, ypTNM stage was the sole independent prognostic factor for DFS (P=0.042). Tumors invading an adjacent organ or involving distant lymph nodes showed better survival than those with peritoneal seeding or solid organ metastasis (P=0.084). Kaplan-Meier curves showed that the 3-year OS rate of patients with pathologic CR and those with CR of the primary tumor but residual node metastasis was 81.8% and 80.0%, respectively. OS was 65.8% for stage 1 patients, 49.8% for those at stage 2, and 36.3% for those at stage 3. Conclusions: The ypTNM staging is a significant prognostic factor in patients who underwent CVS for localized unresectable or stage IV gastric cancers. Patients with locally advanced but unresectable lesions or with tumors with distant nodal metastasis may be good candidates for CVS.

• 스마트미디어저널
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• 제9권4호
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• pp.126-133
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• 2020

병원에서는 폐암 환자의 최종병기를 기준으로 치료방침 및 예후를 결정하고 있다. 폐암 환자의 최종병기는 미국 암 연합회(AJCC)에서 제공하는 TNM 분류방법을 바탕으로 7단계로 나누어 진단된다. 이런 접근 방법은 환자의 치료, 예후 및 생존일 예측 등 다양한 분야에서 사용하기에 한계가 있다. 이 논문에서는 데이터 과학적 접근을 통해 T, N, M병기를 사용하여 생존일수별 환자집단을 나눌 수 있는지 알아보기 위해 비지도 학습 중 하나인 군집분석(Clustering)을 진행한 후 군집분석의 결과를 Cox비례위험모형을 사용하여 비교 하였다. 환자들의 최종병기를 사용하지 않고, T, N, M병기 정보만 사용하였을 때 생존시간 예측정확도가 더 높은 것을 확인하였다. 특히, AJCC의 최종병기 7단계와 같이 군집의 개수를 7로 설정했을 때보다 군집의 수를 축소하거나 확장했을 때 T, N, M 병기 군집분석을 통한 생존시간 예측정확도가 향상하는 것을 확인하였다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권3호
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• pp.2091-2095
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• 2013

Background: The $7^{th}$ TNM staging is the first authoritative standard for evaluation of effectiveness of treatment of gastric cancer worldwide. However, revision of pN classification within TNM needs to be discussed. In particular, the N3 sub-stage is becoming more conspicuous. Methods: Clinical data of 302 pN3M0 stage gastric cancer patients who received radical gastrectomy in Tianjin Medical University Cancer Institute and Hospital from January 2001 to May 2006 were retrospectively analyzed. Results: Location of tumor, depth of invasion, extranodal metastasis, gastric resection, combined organs resection, lymph node metastasis, rate of lymph node metastasis, negative lymph nodes count were important prognostic factors of pN3M0 stage gastric cancers. TNM stage was also associated with prognosis. Patients at T2N3M0 stage had a better prognosis than other sub-classification. T3N3M0 and T4aN3aM0 patients had equal prognosis which followed the T2N3M0. T4aN3bM0 and T4bN3aM0 had lower survival rate than the formers. T4bN3bM0 had worst prognosis. In multivariate analysis, TNM stage group and rate of lymph node metastasis were independent prognostic factors. Conclusions: The sub-stage of N3 may be useful for more accurate prediction of prognosis; it should therefore be applied in the TNM stage system.

• Journal of Yeungnam Medical Science
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• 제36권2호
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• pp.124-135
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• 2019

Background: We aimed to establish robust histoprognostic predictors on residual rectal cancer after preoperative chemoradiotherapy (CRT). Methods: Analyzing known histoprognostic factors in 146 patients with residual disease allows associations with patient outcome to be evaluated. Results: The median follow-up time was 77.8 months, during which 59 patients (40.4%) experienced recurrence and 41 (28.1%) died of rectal cancer. On univariate analysis, residual tumor size, ypT category, ypN category, ypTNM stage, downstage, tumor regression grade, lymphatic invasion, perineural invasion, venous invasion, and circumferential resection margin (CRM) were significantly associated with recurrence free survival (RFS) or/and cancer-specific survival (CSS) (all p<0.005). On multivariate analysis, higher ypTNM stage and CRM positivity were identified as independent prognostic factors for RFS (ypTNM stage, p=0.024; CRM positivity, p<0.001) and CSS (p=0.022, p=0.017, respectively). Furthermore, CRM positivity was an independent predictor of reduced RFS and CSS, irrespective of subgrouping according to downstage (non-downstage, p<0.001 and p<0.001; downstage, p=0.002 and p=0.002) or lymph node metastasis (non-metastasis, p<0.001 and p=0.001; metastasis, p<0.001 and p<0.001). Conclusion: CRM status may be as powerful as ypTNM stage as a prognostic indicator for patient outcome in patients with residual rectal cancer after preoperative CRT.

• Journal of Gastric Cancer
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• 제17권3호
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• pp.212-219
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• 2017

Purpose: The aims of this study were to compare the 7th and 8th editions of the American Joint Committee on Cancer (AJCC) staging manuals on tumor, node, and metastasis (TNM) staging systems and to evaluate whether the 8th edition represents a better refinement of the 7th staging system, when applied for the classification of gastric cancers. Materials and Methods: A total of 5,507 gastric cancer patients, who underwent treatment from January 1989 to December 2013 at a single institute, were included. We compared patient survival rates across the disease groups classified according to the 7th and 8th editions of the AJCC TNM staging systems. Results: Stage migration was observed in 6.4% (n=355) of the patients. Of these, 3.5% (n=192) and 2.9% (n=158) of patients showed a higher stage and lower stage, respectively. According to the 8th edition of the AJCC TNM staging criteria, the 5-year overall survival rates of the patients with stage IIIB and IIIC showed a significant difference (40.8% vs. 20.2%, P<0.001) whereas no significant differences in the 5-year overall survival rates were observed according to the 7th edition criteria (37.6% vs. 33.2%, P=0.381). Conclusions: Restaging stage III cancers according to the 8th edition of the AJCC TNM classification criteria improved survival rate discrimination, particularly, in institutes where the stage III patients were not distinctly categorized.

• Journal of Gastric Cancer
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• 제11권2호
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• pp.78-85
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• 2011

Since January of 2010, the seventh edition of UICC tumor node metastasis (TNM) Classification, which has recently been revised, has been applied to almost all cases of malignant tumors. Compared to previous editions, the merits and demerits of the current revisions were analyzed. Many revisions have been made for criteria for the classification of lymph nodes. In particular, all the cases in whom the number of lymph nodes is more than 7 were classified as N3 without being differentiated. Therefore, the coverage of the N3 was broad. Owing to this, there was no consistency in predicting the prognosis of the N3 group. By determining the positive cases to a distant metastasis as TNM stage IV, the discrepancy in the TNM stage IV compared to the sixth edition was resolved. In regard to the classification system for an esophagogastric (EG) junction carcinoma, it was declared that cases of an invasion to the EG junction should follow the classification system for esophageal cancer. A review of clinical cases reported from Asian patients suggests that it would be more appropriate to follow the previous editions of the classification system for gastric cancer. In addition, in the classification of the TNM stages in the overall cases, the discrepancy in the prognosis between the different stages and the consistency in the prognosis between the same TNM stages were achieved to a lesser extent as compared to that previously. Accordingly, further revisions are needed to develop a purposive classification method where the prognosis can be predicted specifically to each variable and the mode of the overall classification can be simplified.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제45권2호
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• pp.83-90
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• 2019

Objectives: This study evaluated the predictive factors for survival of patients with oral squamous cell carcinoma (OSCC) and investigated the overall and disease-specific survival (DSS) outcomes. Materials and Methods: A total of 67 consecutive patients who underwent surgery for OSCC from January 2006 to November 2014 were included in this study. Patients were classified according to age, sex, pTNM stages, primary sites, smoking and alcohol drinking habits, depth of invasion, perineural and lymphovascular invasion, cell differentiation and postoperative radiotherapy. Kaplan-Meier methods were used to estimate the survival categorized by patient groups. Cox regression methods were used to investigate the main independent predictors of survival. Results: Nineteen patients died of OSCC during follow-up periods. Another five patients died of other diseases including lung adenocarcinoma (n=1), cerebral infarction (n=1), general weakness (n=2), and pneumonia (n=1). The tongue (n=16) was the most common site for primary origin, followed by buccal mucosa (n=15), mandibular gingiva (n=15), maxillary gingiva (n=9), floor of mouth (n=9), retromolar trigone (n=2), and palate (n=1). Eleven patients had pTNM stage I disease, followed by stage II (n=22) and stage IV (n=34). No patients had pTNM stage III disease in this study. The overall survival of all patients was 64.2% and the DSS was 71.6%. DSS of patients with stage I and II disease was 100%. Stepwise Cox regression showed the two predictors for DSS were pTNM stage (P<0.0001, odds ratio=19.633) and presence of metastatic lymph nodes (P=0.0004, odds ratio=0.1039). Conclusion: OSCC has been associated with poor prognosis; however, there were improved survival outcomes compared with past studies. Advanced-stage disease and presence of metastatic lymph nodes were associated with poorer survival compared with early-stage OSCC and absence of neck node metastasis. Stage I and II OSCC were associated with excellent survival results in this study.