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Mark D. Duncan, MD

Arch Surg. 2009;144(1):45.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The efficacy of resection in properly selected patients with stage IV gastric cancer is established. An et al convincingly propound subclassification of advanced gastric cancer based on outcomes from a high-volume center. They demonstrate improved outcome for T1-3N3M0 cancers resected with D2 lymphadenectomy (5-year survival, 27.1%) compared with T(any)N(any)M1 (5-year survival, 9.3%) and T4N1-3M0 disease (5-year survival, 18.3%). I agree with the authors, but 27.1% long-term survival does not to my sentiment warrant classification as stage IV disease. I would thus advocate that the more favorable T1-3N3M0 group (group 2) be classified as stage IIIC (not unlike colorectal cancer staging); the T4N1-3M0, stage IVA; and T(any)N(any)M1, stage IVB. Diagnosis of N3 disease can only be made if adequate lymphadenectomy is performed, which is not achieved in up to a quarter of US patients. Although the Medical Research Council¹ and Dutch trials^2-3 fail to show survival benefit . . . [Full Text of this Article]

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Proposal to Subclassify Stage IV Gastric Cancer Into IVA, IVB, and IVM
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