Abstract
Background: Intergroup 0116 (Southwest Oncology Group 9008), a national, multicenter, two-armed, prospective, randomized trial of adjuvant postoperative chemoradiotherapy, has demonstrated significant benefit. Methods: We prospectively captured complete surgical information, including the treatment of various lymph node stations, for 553 of the 556 eligible participants in this trial. Before any survival analysis, we coded D level by using the Japanese general rules and used the Maruyama program to estimate the likelihood of disease in undissected regional node stations, defining the sum of these estimates as the Maruyama Index of Unresected Disease (MI). We analyzed survival with Cox multivariate regression. Results: Fifty-four percent of participating patients underwent D0 lymphadenectomy. The median MI was 70 (range, 0-429). In contrast to D level, MI proved to be an independent prognostic factor, even with adjustment for the potentially linked variables of T stage and number of positive nodes. We detected no significant interaction between surgical or pathologic variables and the favorable effect of adjuvant treatment, but the power to detect such interaction was generally low. Conclusions: MI, a measure of unresected regional nodal disease in gastric cancer, proved an independent predictor of survival. Surgical undertreatment, as observed in this trial, clearly undermined survival.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 278-286 |
| Number of pages | 9 |
| Journal | Annals of Surgical Oncology |
| Volume | 9 |
| Issue number | 3 |
| DOIs | |
| State | Published - 2002 |
| Externally published | Yes |
Fingerprint
Keywords
- Gastric cancer
- Lymphadenectomy
- Quality
- Stomach cancer
- Surgery
- Survival
ASJC Scopus subject areas
- Surgery
- Oncology
Cite this
Surgical treatment variation in a prospective, randomized trial of chemoradiotherapy in gastric cancer : The effect of undertreatment. / Hundahl, Scott A; Macdonald, John S.; Benedetti, Jacqueline; Fitzsimmons, Thomas.
In: Annals of Surgical Oncology, Vol. 9, No. 3, 2002, p. 278-286.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Surgical treatment variation in a prospective, randomized trial of chemoradiotherapy in gastric cancer
T2 - The effect of undertreatment
AU - Hundahl, Scott A
AU - Macdonald, John S.
AU - Benedetti, Jacqueline
AU - Fitzsimmons, Thomas
PY - 2002
Y1 - 2002
N2 - Background: Intergroup 0116 (Southwest Oncology Group 9008), a national, multicenter, two-armed, prospective, randomized trial of adjuvant postoperative chemoradiotherapy, has demonstrated significant benefit. Methods: We prospectively captured complete surgical information, including the treatment of various lymph node stations, for 553 of the 556 eligible participants in this trial. Before any survival analysis, we coded D level by using the Japanese general rules and used the Maruyama program to estimate the likelihood of disease in undissected regional node stations, defining the sum of these estimates as the Maruyama Index of Unresected Disease (MI). We analyzed survival with Cox multivariate regression. Results: Fifty-four percent of participating patients underwent D0 lymphadenectomy. The median MI was 70 (range, 0-429). In contrast to D level, MI proved to be an independent prognostic factor, even with adjustment for the potentially linked variables of T stage and number of positive nodes. We detected no significant interaction between surgical or pathologic variables and the favorable effect of adjuvant treatment, but the power to detect such interaction was generally low. Conclusions: MI, a measure of unresected regional nodal disease in gastric cancer, proved an independent predictor of survival. Surgical undertreatment, as observed in this trial, clearly undermined survival.
AB - Background: Intergroup 0116 (Southwest Oncology Group 9008), a national, multicenter, two-armed, prospective, randomized trial of adjuvant postoperative chemoradiotherapy, has demonstrated significant benefit. Methods: We prospectively captured complete surgical information, including the treatment of various lymph node stations, for 553 of the 556 eligible participants in this trial. Before any survival analysis, we coded D level by using the Japanese general rules and used the Maruyama program to estimate the likelihood of disease in undissected regional node stations, defining the sum of these estimates as the Maruyama Index of Unresected Disease (MI). We analyzed survival with Cox multivariate regression. Results: Fifty-four percent of participating patients underwent D0 lymphadenectomy. The median MI was 70 (range, 0-429). In contrast to D level, MI proved to be an independent prognostic factor, even with adjustment for the potentially linked variables of T stage and number of positive nodes. We detected no significant interaction between surgical or pathologic variables and the favorable effect of adjuvant treatment, but the power to detect such interaction was generally low. Conclusions: MI, a measure of unresected regional nodal disease in gastric cancer, proved an independent predictor of survival. Surgical undertreatment, as observed in this trial, clearly undermined survival.
KW - Gastric cancer
KW - Lymphadenectomy
KW - Quality
KW - Stomach cancer
KW - Surgery
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=0036217320&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036217320&partnerID=8YFLogxK
U2 - 10.1245/aso.2002.9.3.278
DO - 10.1245/aso.2002.9.3.278
M3 - Article
C2 - 11923135
AN - SCOPUS:0036217320
VL - 9
SP - 278
EP - 286
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
SN - 1068-9265
IS - 3
ER -