title: Surgical pathology stage by American Joint Commission on Cancer criteria predicts patient survival after preoperative chemoradiation for localized gastric carcinoma.
abstract: BACKGROUND
  Preoperative chemoradiation for localized gastric cancer can modify baseline stage, as determined by surgical pathology stage. Therefore, the authors hypothesized that surgical pathology stage would be a better prognosticator of overall survival (OS) than baseline stage.
  
  
  METHODS
  Patient populations were combined from 2 prospectively conducted, preoperative chemoradiation trials that used the same therapeutic strategy. Patients must have had localized gastric adenocarcinoma and were staged extensively, including endoscopic ultrasonography and laparoscopy. Patients had to be fit for surgery medically with a technically resectable cancer. All patients provided written informed consent. Patients first received induction chemotherapy for up to 2 months followed by chemoradiation (45 grays) and an attempted surgery. OS was correlated with pretreatment and posttreatment parameters, including surgical pathology stage according to American Joint Commission on Cancer criteria.
  
  
  RESULTS
  Of 74 patients who were registered, 69 patients (93%) had undergone surgery. Nineteen patients (26%) had a pathologic complete response (pathCR), and 55 patients (81%) had a curative (R0) resection. None of the pretreatment parameters correlated with OS; however, longer OS correlated with lower pathologic stage (P < .0001), R0 resection (P < .001), clinical response noted prior to surgery (P = .002), pathCR (P = .004), lower pathologic lymph node classification (P = .006), and lower pathologic tumor classification (P = .03). Pathologic stage and R0 resection were independent prognostic factors for OS (multivariate Cox model; both P = .05).
  
  
  CONCLUSIONS
  When preoperative chemoradiation strategy was employed for gastric cancer, the surgical pathology stage, a reflection of cancer's biologic heterogeneity, was a better prognosticator of OS than the baseline clinical stage. Surgical pathology stage, in this setting, may serve as an intermediate endpoint for Phase II/III trials.
authors.affiliation: Department of Gastrointestinal Medical Oncology, the University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Pooja R
authors.initials: PR
authors.lastname: Rohatgi
authors.forename: Paul F
authors.initials: PF
authors.lastname: Mansfield
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Crane
authors.forename: Tsung-Teh
authors.initials: TT
authors.lastname: Wu
authors.forename: Punita K
authors.initials: PK
authors.lastname: Sunder
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Morris
authors.forename: Peter W
authors.initials: PW
authors.lastname: Pisters
authors.forename: Barry W
authors.initials: BW
authors.lastname: Feig
authors.forename: Leonard L
authors.initials: LL
authors.lastname: Gunderson
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010340:Pathology, Surgical; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D011878:Radiotherapy; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy