ABSTRACT
AIMS: To determine the eventual advantage of the new 1997 TNM as prognosis predictor for gastric cancer patients submitted to an R0 resection and to compare it with two other lymph-node involvement classifications, the 1990 TNM and the Okusa system. METHODS: From January 1980 to December 1995, an R0 resection was performed as primary therapy in 275 cases of gastric cancer. These operations consisted of a total or sub-total gastrectomy and of a D2 type lymph-node dissection. Tumour classification was performed according to 1990 and 1997 TNM systems, and to the Okusa lymph node classification. The statistical methods used to evaluate prognostic value were: Kaplan-Meier survival estimates; the log-rank test for univariate analysis; and Cox's model for multivariate analysis. RESULTS: The 1990 TNM showed the best stratification power in univariate analysis. In multivariate analysis, the Okusa classification was identified as the best prognostic index (P<0.01). The 1997 TNM showed worse stratification capability than the two other systems. CONCLUSIONS: In the present series, the new TNM (1997) did not improve the prognostic stratification of lymph-node involvement. An adequate and universal system for lymph-node stratification is necessary and further validation of these classifications is needed.
