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Accuracy of preoperative clinical staging for locally advanced gastric cancer in KLASS-02 randomized clinical trial

Kim, DJ | Hyung, WJ | Park, YK | Lee, HJ | An, JY | Kim, HI | Kim, HH | Ryu, SW | Hur, H  | Kim, MC | Kong, SH | Kim, JJ | Park, DJ | Ryu, KW | Kim, YW | Kim, JW | Lee, JH | Yang, HK | Han, SU  | Kim, W | Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS) Group
Frontiers in surgery, 9. : 1001245-1001245, 2022
Journal Title
Frontiers in surgery
PURPOSE: The discrepancy between preoperative and final pathological staging has been a long-standing challenge for the application of clinical trials or appropriate treatment options. This study aimed to demonstrate the accuracy of preoperative staging of locally advanced gastric cancer using data from a large-scale randomized clinical trial. MATERIALS AND METHODS: Of the 1050 patients enrolled in the clinical trial, 26 were excluded due to withdrawal of consent (n = 20) or non-surgery (n = 6). The clinical and pathological staging was compared. Risk factor analysis for underestimation was performed using univariate and multivariate analyses. RESULTS: Regarding T staging by computed tomography, accuracy rates were 74.48, 61.62, 58.56, and 85.16% for T1, T2, T3 and T4a, respectively. Multivariate analysis for underestimation of T staging revealed that younger age, ulcerative gross type, circular location, larger tumor size, and undifferentiated histology were independent risk factors. Regarding nodal status estimation, 54.9% of patients with clinical N0 disease were pathologic N0, and 36.4% of patients were revealed to have pathologic N0 among clinical node-positive patients. The percentage of metastasis involvement at the D1, D1+, and D2 lymph node stations significantly increased with the advanced clinical N stage. Among all patients, 29 (2.8%), including 26 with peritoneal seeding, exhibited distant metastases. CONCLUSIONS: Estimating the exact pathologic staging remains challenging. A thorough evaluation is mandatory before treatment selection or trial enrollment. Moreover, we need to set a sufficient case number when we design the clinical trial considering the stage migration.

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Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
Ajou Authors
한, 상욱  |  허, 훈
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