Consideration of clinicopathologic features improves patient stratification for multimodal treatment of gastric cancer

Abstract

Preoperative staging of gastric cancer with computed tomography alone exhibits poor diagnostic accuracy, which may lead to improper treatment decisions. We developed novel patient stratification criteria to select appropriate treatments for gastric cancer patients based on preoperative staging and clinicopathologic features. A total of 5352 consecutive patients who underwent gastrectomy for gastric cancer were evaluated. Preoperative stages were determined according to depth of invasion and nodal involvement on computed tomography. Logistic regression analysis was used to identify clinicopathological factors associated with the likelihood of proper patient stratification. The diagnostic accuracies of computed tomography scans for depth of invasion and nodal involvement were 67.1% and 74.1%, respectively. Among clinicopathologic factors, differentiated tumor histology, tumors smaller than 5 cm, and gross appearance of early gastric cancer on endoscopy were shown to be related to a more advanced stage of disease on preoperative computed tomography imaging than actual pathological stage. Additional consideration of undifferentiated histology, tumors larger than 5 cm, and grossly advanced gastric cancer on endoscopy increased the probability of selecting appropriate treatment from 75.5% to 94.4%. The addition of histology, tumor size, and endoscopic findings to preoperative staging improves patient stratification for more appropriate treatment of gastric cancer.

Are Borrmann’s Types of Advanced Gastric Cancer Distinct Clinicopathological and Molecular Entities? A Western Study

“…In recent years, several molecular classifications have been proposed, including The Cancer Genome Atlas and the Asian Cancer Research Group (ACRG) systems [ 6 , 7 ]. However, these classifications have not yet been translated into clinical practice [ 8 , 9 , 10 ].…”

“…However, resected patients in Western countries still show poor survival rates and treatment options after surgery have not significantly changed in recent years. Several authors have highlighted the need to improve the stratification of GC patients for clinical trials and/or patient management, in order to find groups of patients who would benefit from different treatment options [ 8 , 9 , 10 ]. Molecular classifications are complex and expensive, so other investigators have analyzed the new roles of “classical” and cost-effective histologic features, such as the Laurén classification, which may reflect the biological heterogeneity of GC [ 8 , 9 ].…”

Epidemiología Del Cáncer De Estómago en Un Centro De Referencia Del Ecuador.

“…En un estudio realizado en Colombia en la ciudad de Bucaramanga por Bermúdez y colaboradores (11) se encontró que la localización más frecuente del tumor fue antro-pilórica y la totalidad de los casos se diagnosticaron en estadio III y IV; mientras que en la población del Hospital Universitario de Neira (12) la localización más frecuente del tumor fue el antro seguido por el cuerpo gástrico, el 59,1% de los casos se diagnosticaron en estadio III y IV, a diferencia de nuestro estudio en el que encontramos que la localización más frecuente fue el cuerpo gástrico seguido del antro. Con relación al estadio al momento del diagnóstico, el 72% de los casos de nuestro estudio fueron realizados en fase III y IV, es decir el diagnóstico se lo realizó en fases avanzadas de la enfermedad, datos semejantes a los estudios realizados en Colombia, etapas asociadas a peor pronóstico.…”

“…El diagnóstico se lo realiza mediante biopsia tomada por endoscopia digestiva alta, su principal contribución es la determinación del subtipo histológico -intestinal o difuso, siendo este último el que presenta asociaciones genéticas más importantes y presentaciones o diagnósticos a edad más temprana (11) .…”