Can modified dukes' classification be used in gastric cancer staging?

Abstract

Aim: Dukes' staging system is a simple system used widely in the staging of colorectal cancer. This study was designed to analyze the applicability of the modified Dukes' classification system in gastric cancer cases. Methods: The prognostic factors affecting survival in 139 gastric cancer cases who had had at least 15 lymph nodes removed were analyzed. Modified Dukes' and TNM classifications were investigated to correlate statistically significant prognostic factors. The investigated prognostic factors were age, tumor size, histological type, differentiation, localization and number of the lymph nodes removed, and the ratio of number of metastatic lymph nodes to the number of lymph nodes removed. Results: Tumor size >10 cm, muscularis propria and serosa invasion, >6 invaded lymph nodes and metastatic lymph node ratio >0.29 were statistically significant poor prognostic factors in multivariate analysis. The two staging systems were in correlation with these poor prognostic factors. There was no statistical difference between receiver operating characteristics curves of the two systems. When the survival curves were examined, it was seen that Dukes' staging had a more stepwise curve than the TNM system. Conclusion: Dukes' staging system is in correlation with prognostic factors in gastric cancer. It can be easily recalled. Dukes' A stage when applied to gastric cancer defines a good prognosis group. The reclassification of T2N0 tumors as early gastric cancer is an area of speculation which needs to be investigated separately. © TÜBİTAK.