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-  2019 

Staging systems for gastric cancer: more complex than TNM

DOI: 10.21037/tgh.2019.05.11

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Gastric cancer is an aggressive malignancy with varying incidences worldwide. Accurate staging systems are necessary in order to help determine prognosis and guide treatment. Given the rapidly evolving role of multi-modal systemic (chemotherapy, targeted therapy) and regional (chemoradiation) therapy in both the neoadjuvant and adjuvant setting, there is an even greater need for comprehensive and accurate prognostic staging systems. As such, we read with great interest the current study by Ye and colleagues in Surgical Oncology that externally validated the 8th American Joint Commission on Cancer (AJCC) and the modified 8th AJCC system for advanced gastric cancer. The authors utilized a large cohort of 684 patients from a single institution in Southern China. Compared with the AJCC 7th edition, the authors noted that stage migration occurred in 23.2% of patients. Utilizing a cutoff of 30 lymph nodes (LN) retrieved, the authors reported that stage migration occurred in 15.8% of patients from the AJCC 8th edition to the modified 8th AJCC edition. These data add a new perspective to the literature on the staging of advanced gastric cancer. However, as with any large retrospective database study, a number of important factors need to be considered


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