Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer

Pooja Patel, Paul F. Mansfield, Christopher H. Crane, Tsung Teh Wu, Jeffrey H. Lee, Patrick M. Lynch, Jeffrey Morris, Peter W. Pisters, Barry Feig, Punita K. Sunder, Julie G. Izzo, Jaffer A. Ajani

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

BACKGROUND. For patients with localized gastric cancer (LGC) who are receiving preoperative chemoradiation (CTRT), the postsurgical pathologic stage predicts overall survival (OS) better than the baseline stage. The authors hypothesized that presurgical (postCTRT) stage would also correlate better with patient outcome than the baseline stage. METHODS. The authors analyzed 74 LGC patients treated with preoperative CTRT receiving similar treatment. Patients were staged with baseline endoscopic ultrasonography (EUS) and laparoscopy. Patients received induction chemotherapy, then CTRT (45 Gy), and had an attempted surgery. After CTRT, patients had complete preoperative staging including EUS in 35 patients. RESULTS. Thirty-five had all 3 sets of staging, baseline, presurgical, and postsurgical. Baseline stage did not associate with OS (P = .16) nor disease-free survival (DFS; P = .13). However, presurgical stage was associated with OS (P = .01), and DFS (P = .05). OS was also associated with postsurgical stage and was longer for stages 0 and I than for stages III and IV (P = .01 and .04, respectively). Similarly, DFS was longer in postsurgical pathologic stages 0, I, and II than in stage III or IV (P <.001, <.001, and <.01, respectively). Baseline staging did not correlate with the proportion of patients alive at 4 years; however, presurgical staging did. Patients with stage I or II survived longer than those with stage III or IV (81% vs 25%; P<.01). CONCLUSIONS. Heterogeneity in clinical biology of LGC is best reflected after CTRT in presurgical and postsurgical pathologic stages rather than by the baseline stage. Correlation of outcome with presurgical staging may facilitate strategies to individualize therapy for LGC.

Original languageEnglish (US)
Pages (from-to)989-995
Number of pages7
JournalCancer
Volume110
Issue number5
DOIs
StatePublished - Sep 1 2007
Externally publishedYes

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Stomach Neoplasms
Endosonography
Survival
Induction Chemotherapy
Laparoscopy
Disease-Free Survival
Therapeutics

Keywords

  • Disease-free survival
  • Gastric cancer
  • Overall survival
  • Preoperative chemoradiation
  • Surgery

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer. / Patel, Pooja; Mansfield, Paul F.; Crane, Christopher H.; Wu, Tsung Teh; Lee, Jeffrey H.; Lynch, Patrick M.; Morris, Jeffrey; Pisters, Peter W.; Feig, Barry; Sunder, Punita K.; Izzo, Julie G.; Ajani, Jaffer A.

In: Cancer, Vol. 110, No. 5, 01.09.2007, p. 989-995.

Research output: Contribution to journalArticle

Patel, P, Mansfield, PF, Crane, CH, Wu, TT, Lee, JH, Lynch, PM, Morris, J, Pisters, PW, Feig, B, Sunder, PK, Izzo, JG & Ajani, JA 2007, 'Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer', Cancer, vol. 110, no. 5, pp. 989-995. https://doi.org/10.1002/cncr.22870
Patel, Pooja ; Mansfield, Paul F. ; Crane, Christopher H. ; Wu, Tsung Teh ; Lee, Jeffrey H. ; Lynch, Patrick M. ; Morris, Jeffrey ; Pisters, Peter W. ; Feig, Barry ; Sunder, Punita K. ; Izzo, Julie G. ; Ajani, Jaffer A. / Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer. In: Cancer. 2007 ; Vol. 110, No. 5. pp. 989-995.
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abstract = "BACKGROUND. For patients with localized gastric cancer (LGC) who are receiving preoperative chemoradiation (CTRT), the postsurgical pathologic stage predicts overall survival (OS) better than the baseline stage. The authors hypothesized that presurgical (postCTRT) stage would also correlate better with patient outcome than the baseline stage. METHODS. The authors analyzed 74 LGC patients treated with preoperative CTRT receiving similar treatment. Patients were staged with baseline endoscopic ultrasonography (EUS) and laparoscopy. Patients received induction chemotherapy, then CTRT (45 Gy), and had an attempted surgery. After CTRT, patients had complete preoperative staging including EUS in 35 patients. RESULTS. Thirty-five had all 3 sets of staging, baseline, presurgical, and postsurgical. Baseline stage did not associate with OS (P = .16) nor disease-free survival (DFS; P = .13). However, presurgical stage was associated with OS (P = .01), and DFS (P = .05). OS was also associated with postsurgical stage and was longer for stages 0 and I than for stages III and IV (P = .01 and .04, respectively). Similarly, DFS was longer in postsurgical pathologic stages 0, I, and II than in stage III or IV (P <.001, <.001, and <.01, respectively). Baseline staging did not correlate with the proportion of patients alive at 4 years; however, presurgical staging did. Patients with stage I or II survived longer than those with stage III or IV (81{\%} vs 25{\%}; P<.01). CONCLUSIONS. Heterogeneity in clinical biology of LGC is best reflected after CTRT in presurgical and postsurgical pathologic stages rather than by the baseline stage. Correlation of outcome with presurgical staging may facilitate strategies to individualize therapy for LGC.",
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T1 - Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer

AU - Patel, Pooja

AU - Mansfield, Paul F.

AU - Crane, Christopher H.

AU - Wu, Tsung Teh

AU - Lee, Jeffrey H.

AU - Lynch, Patrick M.

AU - Morris, Jeffrey

AU - Pisters, Peter W.

AU - Feig, Barry

AU - Sunder, Punita K.

AU - Izzo, Julie G.

AU - Ajani, Jaffer A.

PY - 2007/9/1

Y1 - 2007/9/1

N2 - BACKGROUND. For patients with localized gastric cancer (LGC) who are receiving preoperative chemoradiation (CTRT), the postsurgical pathologic stage predicts overall survival (OS) better than the baseline stage. The authors hypothesized that presurgical (postCTRT) stage would also correlate better with patient outcome than the baseline stage. METHODS. The authors analyzed 74 LGC patients treated with preoperative CTRT receiving similar treatment. Patients were staged with baseline endoscopic ultrasonography (EUS) and laparoscopy. Patients received induction chemotherapy, then CTRT (45 Gy), and had an attempted surgery. After CTRT, patients had complete preoperative staging including EUS in 35 patients. RESULTS. Thirty-five had all 3 sets of staging, baseline, presurgical, and postsurgical. Baseline stage did not associate with OS (P = .16) nor disease-free survival (DFS; P = .13). However, presurgical stage was associated with OS (P = .01), and DFS (P = .05). OS was also associated with postsurgical stage and was longer for stages 0 and I than for stages III and IV (P = .01 and .04, respectively). Similarly, DFS was longer in postsurgical pathologic stages 0, I, and II than in stage III or IV (P <.001, <.001, and <.01, respectively). Baseline staging did not correlate with the proportion of patients alive at 4 years; however, presurgical staging did. Patients with stage I or II survived longer than those with stage III or IV (81% vs 25%; P<.01). CONCLUSIONS. Heterogeneity in clinical biology of LGC is best reflected after CTRT in presurgical and postsurgical pathologic stages rather than by the baseline stage. Correlation of outcome with presurgical staging may facilitate strategies to individualize therapy for LGC.

AB - BACKGROUND. For patients with localized gastric cancer (LGC) who are receiving preoperative chemoradiation (CTRT), the postsurgical pathologic stage predicts overall survival (OS) better than the baseline stage. The authors hypothesized that presurgical (postCTRT) stage would also correlate better with patient outcome than the baseline stage. METHODS. The authors analyzed 74 LGC patients treated with preoperative CTRT receiving similar treatment. Patients were staged with baseline endoscopic ultrasonography (EUS) and laparoscopy. Patients received induction chemotherapy, then CTRT (45 Gy), and had an attempted surgery. After CTRT, patients had complete preoperative staging including EUS in 35 patients. RESULTS. Thirty-five had all 3 sets of staging, baseline, presurgical, and postsurgical. Baseline stage did not associate with OS (P = .16) nor disease-free survival (DFS; P = .13). However, presurgical stage was associated with OS (P = .01), and DFS (P = .05). OS was also associated with postsurgical stage and was longer for stages 0 and I than for stages III and IV (P = .01 and .04, respectively). Similarly, DFS was longer in postsurgical pathologic stages 0, I, and II than in stage III or IV (P <.001, <.001, and <.01, respectively). Baseline staging did not correlate with the proportion of patients alive at 4 years; however, presurgical staging did. Patients with stage I or II survived longer than those with stage III or IV (81% vs 25%; P<.01). CONCLUSIONS. Heterogeneity in clinical biology of LGC is best reflected after CTRT in presurgical and postsurgical pathologic stages rather than by the baseline stage. Correlation of outcome with presurgical staging may facilitate strategies to individualize therapy for LGC.

KW - Disease-free survival

KW - Gastric cancer

KW - Overall survival

KW - Preoperative chemoradiation

KW - Surgery

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