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Proposal of a Dukes-MAC-like staging system for gastric cancer
  1. Simona Gurzu1,
  2. Haruhiko Sugimura2,
  3. Janina Orlowska3,
  4. Janos Szederjesi4,
  5. Zoltan Szentirmay5,
  6. Tivadar Bara6,
  7. Tivadar Bara Jr6,
  8. Ananmaria Fetyko1,
  9. Ioan Jung1
  1. 1Department of Pathology, University of Medicine and Pharmacy, Tirgu Mures, Romania
  2. 2Department of Tumor Pathology, Hamamatsu University, Hamamatsu, Japan
  3. 3Department of Pathology, The Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
  4. 4Department of Intensive Care, University of Medicine and Pharmacy, Tirgu Mures, Romania
  5. 5Department of Molecular Pathology, National Institute of Oncology, Budapest, Hungary
  6. 6Department of Surgery, University of Medicine and Pharmacy, Tirgu Mures, Romania
  1. Correspondence to Dr Janos Szederjesi, University of Medicine and Pharmacy, 38 Ghe Marinescu Street, Tirgu Mures 540139, Romania; yangzi37{at}


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.

  • Stomach
  • Cancer
  • Carcinoma
  • Interdisciplinary Studies

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  • Contributors SG designed the research and drafted the article. HS performed the interpretation of data form western point of vision. JO provided data of Polish patients. JS managed the statistical data. ZS provided data of Hungarian patients. TB participated at the surgical interventions and managed the clinical data. TB. participated at the surgical interventions and managed the data from literature. AF performed the histological daily diagnosis and checked the English quality. IJ reviewed the data and approved the final variant.

  • Funding This paper was partially supported by the University of Medicine and Pharmacy of Tirgu Mures, Romania, team research projects frame: UMFTGM-PO-CC-02-F01—grant number 19/2014.

  • Competing interests None declared.

  • Ethics approval The Ethical Committee of University of Medicine and Pharmacy of Tirgu Mures, Romania.

  • Provenance and peer review Not commissioned; externally peer reviewed.