title: Clinical stage after preoperative chemoradiation is a better predictor of patient outcome than the baseline stage for localized gastric cancer.
abstract: BACKGROUND
  For patients with localized gastric cancer (LGC) who are receiving preoperative chemoradiation (CTRT), the postsurgical pathologic stage predicts overall survival (OS) better than the baseline stage. The authors hypothesized that presurgical (postCTRT) stage would also correlate better with patient outcome than the baseline stage.
  
  
  METHODS
  The authors analyzed 74 LGC patients treated with preoperative CTRT receiving similar treatment. Patients were staged with baseline endoscopic ultrasonography (EUS) and laparoscopy. Patients received induction chemotherapy, then CTRT (45 Gy), and had an attempted surgery. After CTRT, patients had complete preoperative staging including EUS in 35 patients.
  
  
  RESULTS
  Thirty-five had all 3 sets of staging, baseline, presurgical, and postsurgical. Baseline stage did not associate with OS (P = .16) nor disease-free survival (DFS; P = .13). However, presurgical stage was associated with OS (P = .01), and DFS (P = .05). OS was also associated with postsurgical stage and was longer for stages 0 and I than for stages III and IV (P = .01 and .04, respectively). Similarly, DFS was longer in postsurgical pathologic stages 0, I, and II than in stage III or IV (P < .001, <.001, and <.01, respectively). Baseline staging did not correlate with the proportion of patients alive at 4 years; however, presurgical staging did. Patients with stage I or II survived longer than those with stage III or IV (81% vs 25%; P < .01).
  
  
  CONCLUSIONS
  Heterogeneity in clinical biology of LGC is best reflected after CTRT in presurgical and postsurgical pathologic stages rather than by the baseline stage. Correlation of outcome with presurgical staging may facilitate strategies to individualize therapy for LGC.
authors.affiliation: Department of Gastrointestinal Medical Oncology, University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Pooja R
authors.initials: PR
authors.lastname: Patel
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: Jeffrey H
authors.initials: JH
authors.lastname: Lee
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Lynch
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Morris
authors.forename: Peter W
authors.initials: PW
authors.lastname: Pisters
authors.forename: Barry
authors.initials: B
authors.lastname: Feig
authors.forename: Punita K
authors.initials: PK
authors.lastname: Sunder
authors.forename: Julie G
authors.initials: JG
authors.lastname: Izzo
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004358:Drug Therapy / Q000379:methods; D019160:Endosonography; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D011878:Radiotherapy / Q000379:methods; D013274:Stomach Neoplasms / Q000473:pathology* / Q000628:therapy*; D016896:Treatment Outcome