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Accuracy of CT Staging of Locally Advanced Gastric Cancer after Neoadjuvant Chemotherapy: Cohort Evaluation within a Randomized Phase II Study

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

Abstract

Background

Accuracy of the radiologic diagnosis of gastric cancer staging after neoadjuvant chemotherapy remains unclear.

Methods

Patients enrolled in the COMPASS trial, a randomized phase II study comparing two and four courses of S-1 plus cisplatin and paclitaxel and cisplatin followed by gastrectomy, were examined. The radiologic stage was determined by using thin-slice computed tomography (CT) or multidetector low CT by following Habermann’s method.

Results

A total of 75 patients registered in the COMPASS study who underwent surgical resection were examined in this study. The radiologic T and pathologic T stages were not significantly correlated (p = 0.221). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 42.7, 10.7, and 46.7%, respectively. When patients were stratified according to the pathologic response of the primary tumor, the correlation was not significant in either the responders (n = 32, p = 0.410) or the nonresponders (n = 43, p = 0.742). The radiologic accuracy was 37.5% in the responders and 42.7% in the nonresponders. The radiologic N and pathologic N stages were significantly correlated (p = 0.000). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 44, 29.3, and 26.7%, respectively. When stratifying the patients with measurable lymph nodes according only to the radiologic response, the correlation was significant in the nonresponders (n = 23, p = 0.035) but not in the responders (n = 28, p = 0.634). The radiologic accuracy was 39.3% in the responders and 52.1% in the nonresponders.

Conclusions

Restaging using CT after neoadjuvant chemotherapy for gastric cancer is considered to be inaccurate and unreliable. In particular, the radiologic T-staging determined after neoadjuvant chemotherapy should not be considered in clinical decision-making.

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Acknowledgment

This work was supported by the Epidemiological & Clinical Research Information Network (ECRIN).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan

    Takaki Yoshikawa MD, PhD, Shinichi Hasegawa MD, Toru Aoyama MD & Tsutomu Hayashi MD

  2. Department of Gastrointestinal Surgery, Hiroshima University, Hiroshima, Japan

    Kazuaki Tanabe MD

  3. Department of Surgery, Osaka General Medical Center, Osaka, Japan

    Kazuhiro Nishikawa MD

  4. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan

    Yuichi Ito MD

  5. Department of Surgery, Aichi Cancer Center, Aichi Hospital, Okazaki, Japan

    Takanori Matsui MD

  6. Department of Surgery, NTT West Osaka Hospital, Osaka, Japan

    Yutaka Kimura MD, PhD

  7. Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan

    Satoshi Morita PhD

  8. Data Center, Nonprofit Organization ECRIN, Okazaki, Japan

    Yumi Miyashita

  9. Clinical Research Center, Shonan Kamakura General Hospital, Kamakura, Japan

    Akira Tsuburaya MD

  10. Tokai Central Hospital, Kakamigahara, Japan

    Junichi Sakamoto MD

Authors
  1. Takaki Yoshikawa MD, PhD
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  2. Kazuaki Tanabe MD
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  3. Kazuhiro Nishikawa MD
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  4. Yuichi Ito MD
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  5. Takanori Matsui MD
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  6. Yutaka Kimura MD, PhD
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  7. Shinichi Hasegawa MD
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  8. Toru Aoyama MD
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  9. Tsutomu Hayashi MD
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  10. Satoshi Morita PhD
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  11. Yumi Miyashita
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  12. Akira Tsuburaya MD
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  13. Junichi Sakamoto MD
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Corresponding author

Correspondence to Takaki Yoshikawa MD, PhD.

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Yoshikawa, T., Tanabe, K., Nishikawa, K. et al. Accuracy of CT Staging of Locally Advanced Gastric Cancer after Neoadjuvant Chemotherapy: Cohort Evaluation within a Randomized Phase II Study. Ann Surg Oncol 21 (Suppl 3), 385–389 (2014). https://doi.org/10.1245/s10434-014-3615-8

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  • DOI: https://doi.org/10.1245/s10434-014-3615-8

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