Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma

Pooja R. Rohatgi, Paul F. Mansfield, Christopher H. Crane, Tsung Teh Wu, Punita K. Sunder, William A. Ross, Jeffrey S. Morris, Peter W. Pisters, Barry W. Feig, Leonard L. Gunderson, Jaffer A. Ajani

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1475-1482
Number of pages8
JournalCancer
Volume107
Issue number7
DOIs
StatePublished - Oct 1 2006

Keywords

  • Localized gastric carcinoma
  • Preoperative chemoradiation
  • Surgical pathology stage
  • Survival outcome

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Fingerprint Dive into the research topics of 'Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma'. Together they form a unique fingerprint.

  • Cite this

    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., & 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(7), 1475-1482. https://doi.org/10.1002/cncr.22180