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Accuracy of preoperative clinical staging for locally advanced gastric cancer in KLASS-02 randomized clinical trial

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Author(s)
Dong Jin KimWoo Jin HyungYoung-Kyu ParkHyuk-Joon LeeJi Yeong AnHyoung-Il KimHyung-Ho KimSeung Wan RyuHoon HurMin-Chan KimSeong-Ho KongJin-Jo KimDo Joong ParkKeun Won RyuYoung Woo KimJong Won KimJoo-Ho LeeHan-Kwang YangSang-Uk HanWook Kim
Keimyung Author(s)
Ryu, Seung Wan
Department
Dept. of Surgery (외과학)
Journal Title
Front Surg
Issued Date
2022
Volume
9
Keyword
accuracycomputed tomographydiagnosisgastric neoplasmgastroscopy
Abstract
Purpose:
The discrepancy between preoperative and final pathological staging has been a long-standing challenge for the application of clinical trials or appropriate treatment options. This study aimed to demonstrate the accuracy of preoperative staging of locally advanced gastric cancer using data from a large-scale randomized clinical trial.

Materials and methods:
Of the 1050 patients enrolled in the clinical trial, 26 were excluded due to withdrawal of consent (n = 20) or non-surgery (n = 6). The clinical and pathological staging was compared. Risk factor analysis for underestimation was performed using univariate and multivariate analyses.

Results:
Regarding T staging by computed tomography, accuracy rates were 74.48, 61.62, 58.56, and 85.16% for T1, T2, T3 and T4a, respectively. Multivariate analysis for underestimation of T staging revealed that younger age, ulcerative gross type, circular location, larger tumor size, and undifferentiated histology were independent risk factors. Regarding nodal status estimation, 54.9% of patients with clinical N0 disease were pathologic N0, and 36.4% of patients were revealed to have pathologic N0 among clinical node-positive patients. The percentage of metastasis involvement at the D1, D1+, and D2 lymph node stations significantly increased with the advanced clinical N stage. Among all patients, 29 (2.8%), including 26 with peritoneal seeding, exhibited distant metastases.

Conclusions:
Estimating the exact pathologic staging remains challenging. A thorough evaluation is mandatory before treatment selection or trial enrollment. Moreover, we need to set a sufficient case number when we design the clinical trial considering the stage migration
Keimyung Author(s)(Kor)
류승완
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2296-875X
Source
https://www.frontiersin.org/articles/10.3389/fsurg.2022.1001245/full
DOI
10.3389/fsurg.2022.1001245
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44533
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Surgery (외과학)
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