The inaccuracies of gastric adenocarcinoma clinical staging and its predictive factors. Issue 7 (11th March 2023)

• Record Type: Journal Article
• Authors: Janczewski, Lauren M.; Shah, Dhavan; Wells, Amy; Bentrem, David J.; Abad, John D.; Chawla, Akhil
• Is Part Of: Journal of surgical oncology. Volume 127:Issue 7(2023)
• Page Start: 1116
• Page End: 1124
• Publication Date: 2023-03-11
• Subjects: clinical staging -- gastric cancer -- inaccurate staging; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.27233
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Introduction: Accurate clinical staging (CS) of gastric adenocarcinoma is important to guide treatment planning. Our objectives were to (1) assess clinical to pathologic stage migration patterns for patients with gastric adenocarcinoma, (2) identify factors associated with inaccurate CS, and (3) evaluate the association of understaging with survival. Methods: The National Cancer Database was queried for patients who underwent upfront resection for stage I–III gastric adenocarcinoma. Multivariable logistic regression was used to detect factors associated with inaccurate understaging. Kaplan–Meier analyses and cox proportional hazards regression were performed to assess overall survival (OS) for patients with inaccurate CS. Results: Of 14 425 analyzed patients, 5781 (40.1%) patients were inaccurately staged. Factors associated with understaging included treatment at a Comprehensive Community Cancer Program, presence of lymphovascular invasion, moderate to poor differentiation, large tumor size, and T2 disease. Based on overall CS, median OS was 51.0 months for accurately staged patients and 29.5 months for understaged patients (<0.001). Conclusion: Clinical T‐category, large tumor size, and worse histologic features lead to inaccurate CS for gastric adenocarcinoma, impacting OS. Improvements to staging parameters and diagnostic modalities focusing on these factors may improve prognostication.