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.
Highlights
A global health problem, gastric cancer ranks as the third most common cause of cancer-related deaths worldwide [1]
In preoperative clinical staging based on analysis of computed tomography (CT) images, the majority of patients were classified as clinical T1 stage (52.3%) and clinical N- stage (69.4%)
35.5% and 34.3% of patients were overestimated for clinical T2-3 classification and node positivity, respectively
Summary
A global health problem, gastric cancer ranks as the third most common cause of cancer-related deaths worldwide [1]. Development of contrast materials, and applications of stomach cancer-specific protocols, the diagnostic accuracy of CT scans for gastric cancer has improved considerably. The overall diagnostic accuracies of CT scans in predicting tumor depth and nodal status range from 71.4% to 88.9% and 75.9% to 78%, respectively [9,10,11,12]. Such accuracies are insufficient for proper treatment decisions. Studies on preoperative, multimodal treatments have included patients with pathologically early stage gastric cancer who do not require any perioperative or preoperative chemotherapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
