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Introduction:
The 7th TNM staging defines a minimum number of nodes, recommends an optimal number for each T stage, emphasizes the prognostic importance of number of regional nodes involved and upstages based on the number of metastatic lymph nodes.
Aims:
To study the impact of application of 7th TNM rules on nodal staging (N) of resected and pathologically reported oesophago-gastric junctional (OGJ) adenocarcinomas during the last 10 years stratifying them according to the 7th edition TNM staging and to compare against the original staging and assess possible impact of nodal neo-staging on survival.
Methods:
A retrospective database was used to capture the clinico-pathological data of all consecutive curative resections of OGJ adenocarcinomas over the last 10 years in two UK Upper GI Units. Any report with less than 12 lymph nodes was considered inadequate and denoted as (Nx). All cases were re-reported and re-staged according to the 7th TNM staging rules. We compared the impact of the 7th TNM staging rules on neo-staging. Overall survival was analysed using the 6th and 7th TNM staging respectively. Overall survival was sub-stratified into 2 years, 5 years and 10 years post curative resection.
Results:
Fifty seven (57) pathology reports confirming oesophago-gastric junctional adenocarcinomas were reviewed. Adequate lymphadenectomy (minimum of 12 nodes) was noted in 33 patients. Overall stage migration was noted in 36 (63%) reports with the 7th TNM staging. Of those who had adequate lymphadenectomy (33), 20 reports(60.6%) had stage migration.
In terms of survival, one patient was lost to follow up and is not included in the analysis for survival. Patients with Stage 4 disease were not operated on in this cohort.
2 year survival (n=56) using the 7th TNM staging, showed an apparent increase in survival by 12.4% in stage 3 disease with a corresponding decrease in survival by 17.8% in stage 2 disease. 5 year survival (n=34) using the 7th TNM staging, demonstrated 14.8% increase in survival for stage 3 disease and a corresponding decrease by 17.6% for stage 2 disease.
10 year survival (n=10) with the 7th TNM, again demonstrated a 30% increase in apparent survival for stage 3 disease and a corresponding decrease by 40% in stage 2 disease.
For stage 1 disease, there is no significant change in 2 year, 5 year and 10 year survival.
Conclusion:
The 7th edition of TNM staging provides a detailed documentation of the lymphatic staging. The apparent increase in survival in stage 3 disease appears to be compensated for the apparent decrease in survival for stage 2 disease. This better defined lymphatic staging does not seem to predict survival or have a superior prognosticating ability.