TNM and Japanese staging systems for gastric cancer: how do they coexist?

Two staging systems for gastric cancer, International Union Against Cancer (UICC)/TNM and the Japanese classification, have been used widely for clinical practice and research. The two systems started independently in the 1960s, and underwent several revisions and amendments in order to approach each other, but have become more divergent in the latest editions because of characteristics based on different philosophies. The TNM system adopted a number-based system for N-staging that provides easy and accurate prognostic stratification. Comparative studies have shown that the TNM system has greater prognostic power than the Japanese classification. It contains, however, no treatment guidance and should primarily be used as a guide to prognosis. In contrast, the Japanese classification has been designed as a comprehensive guide to treatment, originally for surgeons and pathologists, and today for oncologists and endoscopists as well. Its anatomical-based N-staging was established based on analysis of lymphadenectomy effectiveness, and naturally provides direct surgical guidance. Clinicians should understand the roles of each system and must not mix the systems or terminology when they report their study results.