Endoscopic ultrasound as a pretreatment clinical staging tool for gastric cancer: Association with pathology and outcome Journal Article


Authors: Merkow, R. P.; Herrera, G.; Goldman, D. A.; Gerdes, H.; Schattner, M. A.; Markowitz, A. J.; Strong, V. E.; Brennan, M. F.; Coit, D. G.
Article Title: Endoscopic ultrasound as a pretreatment clinical staging tool for gastric cancer: Association with pathology and outcome
Abstract: Background: Endoscopic ultrasound (EUS) is a guideline-recommended diagnostic test to estimate pretreatment clinical stage in gastric cancer. The impact of EUS to discriminate long-term outcomes has not been established. Objectives: The objectives of our study were to (1) evaluate the association between EUS and pathologic stage; (2) evaluate the ability of EUS to predict disease-specific survival (DSS); and (3) determine how neoadjuvant chemotherapy (NCT) affects these relationships. Methods: A prospective gastric cancer database at a tertiary care cancer center identified 734 patients who underwent curative intent resection. Patients were separated into EUS low-risk (T1–2, N0) and EUS high-risk (T3–4 Nany, or Tany N+) groups. Agreement statistics and 5-year DSS were estimated stratified by NCT. Results: Between 1987 and 2015, 68% (502/734) of patients were not treated with NCT. Among these patients, percentage agreement between EUS and pathology was moderate (individual T stage: 52%; N stage: 70%; risk group: 73%). EUS accurately estimated pathologic risk group in 73% (365/502) of patients, whereas it overestimated pathologic risk group in 19% (93/502) of patients and underestimated risk in 8% (41/502) of patients. EUS in non-NCT staging was able to discriminate DSS for T stage (hazard ratio [HR] 5.07, p < 0.05), N stage (HR 3.58, p < 0.05), and risk group (HR 6.35, p < 0.05). Among patients treated with NCT, EUS was unable to discriminate DSS for T stage (HR 0.94, p > 0.05), N stage (HR 1.46, p > 0.05) and risk group (HR 0.50, p > 0.05). Conclusions: Pretreatment clinical staging based on EUS alone could lead to over- or under treatment in 27% of patients and can discriminate DSS in NCT-naive patients. EUS should be used in the context of other validated clinical risk tools. © 2017, Society of Surgical Oncology.
Keywords: adult; cancer chemotherapy; cancer survival; aged; cancer surgery; survival rate; major clinical study; overall survival; histopathology; cancer patient; cancer staging; antineoplastic agent; diagnostic accuracy; high risk patient; cancer center; stomach cancer; high risk population; tertiary health care; neoadjuvant chemotherapy; adjuvant radiotherapy; disease specific survival; total stomach resection; endoscopic ultrasonography; survival prediction; low risk patient; low risk population; human; male; female; article
Journal Title: Annals of Surgical Oncology
Volume: 24
Issue: 12
ISSN: 1068-9265
Publisher: Springer  
Date Published: 2017-11-01
Start Page: 3658
End Page: 3666
Language: English
DOI: 10.1245/s10434-017-6050-9
PROVIDER: scopus
PUBMED: 28815443
DOI/URL:
Notes: Article -- Export Date: 1 December 2017 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    782 Brennan
  2. Hans Gerdes
    130 Gerdes
  3. Arnold J Markowitz
    109 Markowitz
  4. Vivian Strong
    148 Strong
  5. Daniel Coit
    422 Coit
  6. Mark Schattner
    103 Schattner
  7. Debra Alyssa Goldman
    97 Goldman
  8. Ryan P Merkow
    7 Merkow