The number of metastatic lymph nodes: A promising prognostic determinant for gastric carcinoma in the latest edition of the TNM classification

Background: The number of metastatic regional lymph nodes determines the ne w pN categories in the 5th edition of the TNM classification. Study Design: Our retrospective study was conducted to compare the new meth od of defining lymph node status with the conventional classification, cons isting of the anatomic extent of lymph node metastases, a well-established prognostic factor. The study was based on clinical data for 493 patients wi th gastric carcinomas who underwent potentially curative operations and had histologically confirmed nodal metastases. These patients were stratified into 1) n categories according to the Japanese Classification of Gastric Ca rcinoma, 2) the new pN categories, and 3) the pN categories determined by t he number of metastatic perigastric nodes resected by standard D1 gastrecto my. Survival data were analyzed for each group. Results: The number of metastatic nodes after D2 lymphadenectomy reflected prognosis well and was shown by multivariate analysis to be a strong indepe ndent prognostic factor. When the classification was performed limited to t he metastatic perigastric nodes, stage migration was evident, but the varia ble remained competent as a prognostic indicator. Conclusions: The number of metastatic nodes is a promising determinant in t he new international stage classification. (J Am Coll Surg 1998;187:597-603 . (C) 1998 by the American College of Surgeons).