TY - JOUR
T1 - Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma
AU - Rohatgi, Pooja R.
AU - Mansfield, Paul F.
AU - Crane, Christopher H.
AU - Wu, Tsung Teh
AU - Sunder, Punita K.
AU - Ross, William A.
AU - Morris, Jeffrey S.
AU - Pisters, Peter W.
AU - Feig, Barry W.
AU - Gunderson, Leonard L.
AU - Ajani, Jaffer A.
PY - 2006/10/1
Y1 - 2006/10/1
N2 - BACKGROUND. 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. METHODS. 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. RESULTS. 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 (RO) resection. None of the pretreatment parameters correlated with OS; however, longer OS correlated with lower pathologic stage (P < .0001), RO 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 RO resection were independent prognostic factors for OS (multivariate Cox model; both P =.05). CONCLUSIONS. 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.
AB - BACKGROUND. 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. METHODS. 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. RESULTS. 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 (RO) resection. None of the pretreatment parameters correlated with OS; however, longer OS correlated with lower pathologic stage (P < .0001), RO 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 RO resection were independent prognostic factors for OS (multivariate Cox model; both P =.05). CONCLUSIONS. 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.
KW - Localized gastric carcinoma
KW - Preoperative chemoradiation
KW - Surgical pathology stage
KW - Survival outcome
UR - http://www.scopus.com/inward/record.url?scp=33749632437&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33749632437&partnerID=8YFLogxK
U2 - 10.1002/cncr.22180
DO - 10.1002/cncr.22180
M3 - Article
C2 - 16944539
AN - SCOPUS:33749632437
SN - 0008-543X
VL - 107
SP - 1475
EP - 1482
JO - Cancer
JF - Cancer
IS - 7
ER -