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Margalit O, Yu S, Shacham-Shmueli E, Strauss G, Yang YX, Lawerence YR, Reiss KA, Golan T, Halpern N, Aderka D, Giantonio B, Mamtani R, Boursi B. Benefit for single-agent adjuvant chemotherapy in elderly patients with locally advanced gastric adenocarcinoma. J Cancer Res Clin Oncol 2022; 148:1703-1708. [DOI: 10.1007/s00432-021-03911-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
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Margalit O, Shacham-Shmueli E, Yang YX, Lawerence YR, Levy I, Reiss KA, Golan T, Halpern N, Aderka D, Giantonio B, Mamtani R, Boursi B. Prognostic Implications of Tumor Differentiation in Clinical T1N0 Gastric Adenocarcinoma. Oncologist 2020; 26:e111-e114. [PMID: 32969129 PMCID: PMC7794188 DOI: 10.1002/onco.13542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Current guidelines recommend neoadjuvant chemotherapy in patients with locoregional gastric adenocarcinoma. Patients diagnosed with early stage gastric adenocarcinoma are usually managed with upfront surgical intervention. However, pathologic staging in a subset of these clinically staged patients identifies more advanced locoregional disease requiring adjuvant treatment. Therefore, identifying these patients prior to surgical intervention is critical to ensure employment of the appropriate treatment paradigm. The aim of the current study was to define patient characteristics associated with clinical understaging in early gastric cancer. Methods Using the National Cancer Database (2004–2014) we identified 3,892 individuals with clinical T1N0 gastric adenocarcinoma who underwent upfront definitive surgery, had negative surgical margins, and did not receive preoperative chemotherapy or radiotherapy. Patient characteristics were compared between those with pathologic stage T1N0 disease and those who were upstaged upon surgery. Results Twenty‐seven percent of clinical T1N0 gastric adenocarcinomas had a change in stage because of pathologically defined ≥T2 disease or positive lymph nodes. Individuals who were upstaged had a higher tumor grade compared with those with pathologic stage T1N0 disease. Specifically, 41.9% (530/1,264) of individuals with a poorly differentiated tumor were upstaged, compared with only 10.7% (70/656) with a well‐differentiated tumor. Approximately 75% of cases involved upstaging because of T misclassification. The highest percentage of upstaging was shown for tumors located at the fundus and body of the stomach. Conclusion Upstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy. Implications for Practice Upstaging of clinical T1N0 gastric adenocarcinoma is characterized by higher tumor grade and is mostly a result of a change in T stage. These findings mandate thorough workup in order to identify patients with clinically staged T1N0 disease requiring preoperative chemotherapy. This article evaluates the frequency of upstaging following surgery among cT1N0 gastric cancer and defines the corresponding patient characteristics, with the goal of better identifying those patients who require preoperative chemotherapy.
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Affiliation(s)
- Ofer Margalit
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Einat Shacham-Shmueli
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Yu-Xiao Yang
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Yaacov R Lawerence
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel.,Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Idan Levy
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Israel
| | - Kim A Reiss
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Talia Golan
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Naama Halpern
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Dan Aderka
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel
| | - Bruce Giantonio
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronac Mamtani
- Department of Gastroenterology, Sheba Medical Center, Tel-Hashomer, Israel.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ben Boursi
- Department of Oncology, Sheba Medical Center, Tel-Hashomer, Israel.,Tel-Aviv University, Tel-Aviv, Israel.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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