Vascularizing lymph node dissection for advanced gastric cancer: A single-institution experience

Proposal of a Dukes-MAC-like staging system for gastric cancer

The aim of this study was to present an epidemiological update regarding the classical prognostic parameters of gastric cancer (GC) in 3 countries from Eastern Europe and to suggest a modification of the pTNM staging system. In 333 consecutive cases which were diagnosed between 2003 and 2012 in 3 departments of pathology from Romania, Hungary, and Poland, the following parameters were analyzed: age and gender of patients, tumor localization, macroscopic and microscopic aspects including the degree of discohesivity, depth of tumor infiltration, and pTNM stage. From all of the studied parameters, the following proved to have independent prognostic value, indicating a lower survival rate: presence of distant metastases (p=0.001), lymph node positivity (p=0.0009), depth of tumor infiltration (p=0.04), age over 50 (p=0.02), proximally located tumors (p=0.03), and ulceroinfiltrative or diffusely infiltrative macroscopic aspect (p=0.0002). The pT2N1-3 staged cases showed a worse prognosis compared with the pT3N0 ones (p=0.02). Regardless of depth of invasion, the lymph node status remains the strongest indicator of the survival rate in GC. The pTN staging system should be adapted and a Dukes-MAC-like staging system should include the following groups: stage A1-T1N0, stage A2-T1N1-3, stage B1-T2N0, stage B2-T2N1-3, stage C1-T3N0, stage C2-T3N1-3, and stage D-T4N0-3. The grade of discohesivity/budding is not a prognostic factor in GC.

Understanding the promising role of TCM in gastric cancer treatment and prevention from the perspective of TCM physical constitution theory

Traditional Chinese medicine (TCM) is an important component of comprehensive therapies in gastric cancer. Previous studies have shown that TCM can reduce the side effects of chemotherapy, and prevent and delay the recurrence and metastasis in gastric cancer patients after surgery. However, the population for which TCM treatment is indicated is still undefined. Recently, the physical constitution has been proved to be closely related to pathogenic factors of the body, therapeutic sensitivity and prognosis. To define the population for which TCM treatment is indicated from the perspective of TCM physical constitution theory will help understand the important role of TCM in the prevention and treatment of gastric cancer.