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Prognostic relevance of gastric cancer staging by endoscopic ultrasound

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Abstract

Background

Recent trials and guidelines have established the use of neoadjuvant chemotherapy for resectable UICC stage II to IV gastric cancers. In this setting, preoperative staging is pivotal for correct patient selection. This cohort study was designed to assess the accuracy of endoscopic ultrasound (EUS) and the ability to select correctly patients for neoadjuvant chemotherapy on the basis of survival outcome.

Methods

Eighty-two consecutive Caucasian patients (46 male; median age 72 years) with gastric cancer underwent EUS staging and subsequent surgery without perioperative chemotherapy or radiotherapy. Patients were followed for a median of 800 days postoperatively. Pathology and EUS UICC and T stages were compared and evaluated as predictors of survival using Kaplan–Meier and Cox regression analysis.

Results

The overall accuracy of EUS for UICC classification compared with pathology was 62 %, and the accuracy for delineation of UICC I was 89 %. For the therapeutically relevant differentiation of early gastric cancer (UICC stage I), EUS (mean survival, 2,298 days, R2 = 0.23) and pathology (2,461 days, R2 = 0.24) predicted survival equally well. Similar results were obtained for T staging by EUS (mean survival, 2,065 days for uT1/2, R2 = 0.24) or pathology (2,185 days, R2 = 0.22).

Conclusions

EUS identifies the low risk subgroup (uUICC stage I or uT1/2) with similar performance as pUICC stage I or stage pT1/2 in gastric cancer and very similar survival characteristics. EUS thus may be the noninvasive method of choice for preoperative selection of patients for immediate resection versus neoadjuvant chemotherapy.

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Acknowledgments

Thanks to V. Loening-Baucke for her valuable comments.

Disclosures

Christian Jürgensen, Jana Brand, Michael Nothnagel, Alexander Arlt, Frank Neser, Jörg-Olaf Habeck, Stefan Schreiber, Ulrich Stölzel, Martin Zeitz, and Jochen Hampe have no conflict of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Charité University Medicine Berlin, Berlin, Germany

    Christian Jürgensen & Martin Zeitz

  2. Department of Medicine II, Klinikum Chemnitz, Chemnitz, Germany

    Jana Brand, Frank Neser & Ulrich Stölzel

  3. Institute for Medical Informatics and Statistics, University Hospital Schleswig–Holstein, Campus Kiel, Kiel, Germany

    Michael Nothnagel

  4. Department of Medicine I, University Hospital Schleswig–Holstein, Campus Kiel, Kiel, Germany

    Alexander Arlt, Stefan Schreiber & Jochen Hampe

  5. Department of Pathology, Klinikum Chemnitz, Chemnitz, Germany

    Jörg-Olaf Habeck

  6. Division of Gastroenterology, Rheumatology, and Infectious Diseases, Medical Department, Charité University Medicine Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Christian Jürgensen

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  1. Christian Jürgensen
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  2. Jana Brand
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Correspondence to Christian Jürgensen.

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Jürgensen, C., Brand, J., Nothnagel, M. et al. Prognostic relevance of gastric cancer staging by endoscopic ultrasound. Surg Endosc 27, 1124–1129 (2013). https://doi.org/10.1007/s00464-012-2558-z

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  • DOI: https://doi.org/10.1007/s00464-012-2558-z

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