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

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

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PurposeThe 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 methodsOf 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 Toggle Switch for underestimation was performed using univariate and multivariate analyses.ResultsRegarding 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, TONGUE CLEANER 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.ConclusionsEstimating 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.