Node-negative gastric cancer: a good occasion for studying new prognostic factors

Dr. Liu and Colleagues (1) present an interesting study that adds data to those already available in the literature from both Western (2-4) and Eastern series (5-7). The sense of all these papers, analyzing prognostic factors significantly related with survival in patients correctly staged as N0 (more than 15 lymph nodes removed at surgery), is that of trying to understand in depth if staging whether or grading is more important in determining the fate of patients with gastric cancer. In fact, analyzing the N0 patients may reveal that these patients have simply been treated at an earlier stage of their disease, and this would lead to stress once more the importance of screening practices, or on the contrary, the same analysis could reveal as other parameters that are actually kept in minor consideration (what might be called grading), significantly influence the biological behavior of the disease, which would lead to the need for better molecular characterization of a single tumor in a single patient.