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World J Gastroenterol. Sep 14, 2016; 22(34): 7748-7753
Published online Sep 14, 2016. doi: 10.3748/wjg.v22.i34.7748
Seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up
Stefano Rausei, Laura Ruspi, Federica Galli, Vincenzo Pappalardo, Giuseppe Di Rocco, Francesco Martignoni, Francesco Frattini, Francesca Rovera, Luigi Boni, Gianlorenzo Dionigi
Stefano Rausei, Laura Ruspi, Federica Galli, Vincenzo Pappalardo, Giuseppe Di Rocco, Francesco Martignoni, Francesco Frattini, Francesca Rovera, Luigi Boni, Gianlorenzo Dionigi, Department of Surgery, University of Insubria, 21100 Varese, Italy
Author contributions: Rausei S contributed to conception and design of the study, drafting the article or making critical revisions and finally approved of the version of the article to be published; Ruspi L contributed to conception and design of the study, acquisition of data, analysis and interpretation of data, drafting the article and approved the version of the article to be published; Galli F, Pappalardo V, Di Rocco G and Martignoni F contributed in the acquisition and interpretation of data and finally approved the version of the article to be published; Frattini F, Rovera F, Boni L and Dionigi G contributed making critical revisions and finally approved the version of the article to be published.
Conflict-of-interest statement: None to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stefano Rausei, MD, PhD, Department of Surgery, University of Insubria, Viale Borri 57, 21100 Varese, Italy. stefano.rausei@asst-settelaghi.it
Telephone: +39-332-278867 Fax: +39-332-260260
Received: April 20, 2016
Peer-review started: April 21, 2016
First decision: May 27, 2016
Revised: June 10, 2016
Accepted: July 20, 2016
Article in press: July 21, 2016
Published online: September 14, 2016
Abstract

Seventh tumor-node-metastasis (TNM) classification for gastric cancer, published in 2010, introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity, due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases, positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however, its search in clinical practice is still far from being routinely performed, as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently, many controversies on lymph node staging are still ongoing, with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.

Keywords: Gastric cancer, Staging system, Tumor-node-metastasis, Prognostic factors, Clinical practice

Core tip: After five years since latest tumor-node-metastasis (TNM) classification for gastric cancer staging has been published, we reviewed Literature concerning its accuracy in prognostication and the impact on clinical practice of the statements introduced in 2010. While waiting for the next UICC/AJCC TNM classification for gastric cancer, open issues and new proposals are also critically discussed.