Skip to main content

Advertisement

SpringerLink
Log in

Clinical Correlation of Endoscopic Ultrasonography with Pathologic Stage and Outcome in Patients Undergoing Curative Resection for Gastric Cancer

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Endoscopic ultrasonography (EUS) is considered valuable for preoperative staging of gastric cancer and defining patient eligibility for enrollment in neoadjuvant protocols. The aim of this study was to correlate EUS staging with pathologic evaluation and outcome in patients undergoing curative R0 resection for gastric cancer.

Methods

All patients who underwent preoperative clinical assessment of T/N stage with EUS and subsequent R0 resection for gastric adenocarcinoma between 1993 and 2003 were identified from a prospective database. Patients who received neoadjuvant chemotherapy were excluded. Clinical staging results from preoperative EUS were compared with postoperative pathologic staging results and correlated with clinical outcome.

Results

Two hundred twenty-five patients with gastric cancer underwent EUS followed by R0 resection, without preoperative chemotherapy. The accuracy of the individual EUS T stage was 57% (127 of 223) and was 50% for N stage (110 of 218). Although EUS was less able to predict outcome according to individual T stage, patients with lesions ≤T2 on EUS had a significantly better outcome than patients with lesions ≥T3. Preoperative assessment of risk was not predicted by EUS N stage alone. Patients identified as high risk on EUS and those with a combination of serosal invasion and nodal disease had both the highest concordance with pathology and a significantly worse outcome (P = .02).

Conclusions

The concordance between EUS and pathologic results was lower than expected for individual T and N stages. Patients with lesions ≤T2 had a significantly better prognosis than patients with more advanced lesions. Individual EUS N stage has limited value in preoperative risk assessment. Combined assessment of serosal invasion and nodal positivity on EUS identifies 77% of patients at risk for death from gastric cancer after curative resection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

FIG. 1.
FIG. 2.
FIG. 3.
FIG. 4.
FIG. 5.

Similar content being viewed by others

References

  1. Cancer Facts and Figures 2006. Available at: http://www.cancer.org/docroot/stt/stt_0.asp, accessed on 5 September 2006

  2. Brennan MF. Benefit of aggressive multimodality treatment for gastric cancer. Ann Surg Oncol 1995;2:286–7

    Article  PubMed  CAS  Google Scholar 

  3. Martin RC II, Jaques DP, Brennan MF, Karpeh M. Achieving R0 resection for locally advanced gastric cancer: is it worth the risk of multiorgan resection? J Am Coll Surg 2002; 194:568–77

    Article  PubMed  Google Scholar 

  4. Hochwald SN, Kim S, Klimstra DS, et al. Analysis of 154 actual five-year survivors of gastric cancer. J Gastrointest Surg 2000; 4:520–5

    Article  PubMed  CAS  Google Scholar 

  5. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001; 345:725–30

    Article  PubMed  CAS  Google Scholar 

  6. Cunningham D, Allum W, Stenning S, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. New Engl J 2006; 355:11–20

    Article  CAS  Google Scholar 

  7. Botet JF, Lightdale CJ, Zauber AG, et al. Preoperative staging of gastric cancer: comparison of endoscopic US and dynamic CT. Radiology 1991; 181:426–32

    PubMed  CAS  Google Scholar 

  8. Tio TL, Kallimanis GE. Endoscopic ultrasonography of perigastrointestinal lymph nodes. Endoscopy 1994; 26:776–9

    Article  PubMed  CAS  Google Scholar 

  9. Smith JW, Brennan MF, Botet JF, et al. Preoperative endoscopic ultrasound can predict the risk of recurrence after operation for gastric carcinoma. J Clin Oncol 1993; 11:2380–5

    PubMed  CAS  Google Scholar 

  10. Miller FH, Kochman ML, Talamonti MS, et al. Gastric cancer. Radiologic staging. Radiol Clin North Am 1997; 35:331–49

    PubMed  CAS  Google Scholar 

  11. Lowy AM, Feig BW, Janjan N, et al. A pilot study of preoperative chemoradiotherapy for resectable gastric cancer. Ann Surg Oncol 2001; 8:519–24

    Article  PubMed  CAS  Google Scholar 

  12. Ajani JA, Mansfield PF, Janjan N, et al. Multi-institutional trial of preoperative chemoradiotherapy in patients with potentially resectable gastric carcinoma. J Clin Oncol 2004; 22:2774–80

    Article  PubMed  CAS  Google Scholar 

  13. Shah MA. Recent developments in the treatment of gastric carcinoma. Curr Oncol Rep 2002; 4:193–201

    PubMed  Google Scholar 

  14. Rosch T. Endosonographic staging of gastric cancer: a review of literature results. Gastrointest Endosc Clin North Am 1995; 5:549–57

    CAS  Google Scholar 

  15. Bando E, Kawamura T, Kinoshita K, et al. Magnitude of serosal changes predicts peritoneal recurrence of gastric cancer. J Am Coll Surg 2003; 197:212–22

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors thank Marianne Beninati for her help with data collection. Supported by a grant from the Gelb Foundation.

Author information

Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, New York, 10021, USA

    David Bentrem MD, Murray Brennan MD & Daniel Coit MD

  2. Department of Gastroenterology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, New York, 10021, USA

    Hans Gerdes MD

  3. Department of Pathology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, New York, 10021, USA

    Laura Tang MD

Authors
  1. David Bentrem MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hans Gerdes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Laura Tang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Murray Brennan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Coit MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Coit MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bentrem, D., Gerdes, H., Tang, L. et al. Clinical Correlation of Endoscopic Ultrasonography with Pathologic Stage and Outcome in Patients Undergoing Curative Resection for Gastric Cancer. Ann Surg Oncol 14, 1853–1859 (2007). https://doi.org/10.1245/s10434-006-9037-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9037-5

Keywords

Search

Navigation