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Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma
Article first published online: 30 AUG 2006
Copyright © 2006 American Cancer Society
Volume 107, Issue 7, pages 1475–1482, 1 October 2006
How to Cite
Rohatgi, P. R., Mansfield, P. F., Crane, C. H., Wu, T.-T., Sunder, P. K., Ross, W. A., Morris, J. S., Pisters, P. W., Feig, B. W., Gunderson, L. L. and Ajani, J. A. (2006), Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma. Cancer, 107: 1475–1482. doi: 10.1002/cncr.22180
- Issue published online: 18 SEP 2006
- Article first published online: 30 AUG 2006
- Manuscript Accepted: 27 JUN 2006
- Manuscript Revised: 7 JUN 2006
- Manuscript Received: 19 APR 2006
- Bristol-Myers Squibb Oncology Division
- Cantu, Dallas, Park, and Capporella families
- localized gastric carcinoma;
- surgical pathology stage;
- survival outcome
Preoperative chemoradiation for localized gastric cancer can modify baseline stage, as determined by surgical pathology stage. Therefore, the authors hypothesized that surgical pathology stage would be a better prognosticator of overall survival (OS) than baseline stage.
Patient populations were combined from 2 prospectively conducted, preoperative chemoradiation trials that used the same therapeutic strategy. Patients must have had localized gastric adenocarcinoma and were staged extensively, including endoscopic ultrasonography and laparoscopy. Patients had to be fit for surgery medically with a technically resectable cancer. All patients provided written informed consent. Patients first received induction chemotherapy for up to 2 months followed by chemoradiation (45 grays) and an attempted surgery. OS was correlated with pretreatment and posttreatment parameters, including surgical pathology stage according to American Joint Commission on Cancer criteria.
Of 74 patients who were registered, 69 patients (93%) had undergone surgery. Nineteen patients (26%) had a pathologic complete response (pathCR), and 55 patients (81%) had a curative (R0) resection. None of the pretreatment parameters correlated with OS; however, longer OS correlated with lower pathologic stage (P < .0001), R0 resection (P < .001), clinical response noted prior to surgery (P = .002), pathCR (P = .004), lower pathologic lymph node classification (P = .006), and lower pathologic tumor classification (P = .03). Pathologic stage and R0 resection were independent prognostic factors for OS (multivariate Cox model; both P = .05).
When preoperative chemoradiation strategy was employed for gastric cancer, the surgical pathology stage, a reflection of cancer's biologic heterogeneity, was a better prognosticator of OS than the baseline clinical stage. Surgical pathology stage, in this setting, may serve as an intermediate endpoint for Phase II/III trials. Cancer 2006. © 2006 American Cancer Society.