J Gastric Cancer 2011;11(2):78-85  DOI:10.5230/jgc.2011.11.2.78 Review Article Evaluation of the 7th UICC TNM Staging System of Gastric Cancer Sung Joon Kwon Department of Surgery, Hanyang University College of Medicine, Seoul, Korea Since January of 2010, the seventh edition of UICC tumor node metastasis (TNM) Classification, which has recently been revised, has been applied to almost all cases of malignant tumors. Compared to previous editions, the merits and demerits of the current revisions were analyzed. Many revisions have been made for criteria for the classification of lymph nodes. In particular, all the cases in whom the number of lymph nodes is more than 7 were classified as N3 without being differentiated. Therefore, the coverage of the N3 was broad. Owing to this, there was no consistency in predicting the prognosis of the N3 group. By determining the positive cases to a distant me- tastasis as TNM stage IV, the discrepancy in the TNM stage IV compared to the sixth edition was resolved. In regard to the classification system for an esophagogastric (EG) junction carcinoma, it was declared that cases of an invasion to the EG junction should follow the classification system for esophageal cancer. A review of clinical cases reported from Asian patients suggests that it would be more appro- priate to follow the previous editions of the classification system for gastric cancer. In addition, in the classification of the TNM stages in the overall cases, the discrepancy in the prognosis between the different stages and the consistency in the prognosis between the same TNM stages were achieved to a lesser extent as compared to that previously. Accordingly, further revisions are needed to develop a pur- posive classification method where the prognosis can be predicted specifically to each variable and the mode of the overall classification can be simplified. Key Words: Stomach neoplasms, Neoplasm staging, Lymphnodes Introduction as new diagnostic or treatment methods have been developed. In the disease staging system, it is essential to determine if consistency Tumor node metastasis (TNM) staging provides guidance for can be acquired between the groups for which the same disease selecting the optimal treatment modalities. It also provides infor- stage was determined and how the differentiation could be made mation on the prognosis for both physicians and patients. Further- between groups for which a different disease stage was determined. more, it is also used as a tool by which the treatment outcomes can In addition, the applicability should be considered from a practical be compared at hospitals and in different countries. perspective. That is, it would be ideal to develop the staging system Disease staging based on the TNM classification currently in such a manner that the specificity to each category should be provides a basis for staging almost all cases of a malignant tumor. assured and the overall classification should be simplified. In this This staging method is amended continuously and revised over time regard, this study assessed the seventh edition of TNM staging. Correspondence to: Sung Joon Kwon Department of Surgery, Hanyang University College of Medicine, 17, Haengdang-dong, Seungdong-gu, Seoul 133-792, Korea Tel: +82-2-2290-8453, Fax: +82-2-2281-0224 E-mail: sjkwon@hanyang.ac.kr Received March 23, 2011 Accepted April 30, 2011 The TNM staging for gastric cancer has been included in the first edition of UICC TNM since 1966.(1) Since January, 2010, the revised seventh edition has been used. A review of the revisions on the seventh edition of TNM staging focused mainly on the classification of lymph nodes. In particular, changes were made for the fifth edition published in 1997 compared to previous editions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyrights © 2011 by The Korean Gastric Cancer Association www.jgc-online.org