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PTU-165 The Better Definition of Nodal Staging in the 7Th Edition of TNM Manual does not Predict Survival or Translates into better Prognosticating Ability in Oesophago-Gastric Junctional Adenocarcinoma
  1. R Y Kannan1,
  2. M Davies1,
  3. C Jenkins1,
  4. A Rasheed1
  1. 1Institute of Minimal Access Surgery, Royal Gwent Hospital, Newport, UK

Abstract

Introduction The 7th TNM staging defines a minimum number of nodes, recommends an optimal number for each T stage, emphasises the prognostic importance of number of regional nodes involved and upstages based on the number of metastatic lymph nodes. We intend on studying 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 OGJ 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. Survival was calculated from the time of initial surgery. Two year survival was assessed in the whole group (n = 57). Five year survival for patients operated between 2000 to 2007 (n = 34) and 10 year survival for those operated on between 2000 to 2002 (n = 10). For stage 3b and stage 3c (7th TNM) there was a 12.5%, 8.9% and 8.9% higher survival rate respectively (for 2.5 and 10 years), compared to the original 6th TNM staging for stage 3. Correspondingly for stage 1b, the survival rate was 5.3%, 3.6% and 3.6% respectively.

Conclusion The 7th edition of TNM staging provides a detailed documentation of the lymphatic staging. This better defined lymphatic staging does not seem to predict survival or have a superior prognosticating ability.

Disclosure of Interest None Declared

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