Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial

Autor: W.O. de Steur, Johan L. Dikken, Anouk K. Trip, Jeffrey P.B.M. Braak, Annemieke Cats, W.M. Meershoek-Klein Kranenbarg, Marcel Verheij, E.P.M. Jansen, Hein Putter, J.W. van Sandick, N.C.T. van Grieken, Henk H. Hartgrink, M. I. van Berge Henegouwen, C.J.H. van de Velde, Y.H.M. Claassen
Přispěvatelé: Pathology, AGEM - Re-generation and cancer of the digestive system, CCA - Cancer Treatment and quality of life, Surgery, Radiation Oncology, CCA - Cancer Treatment and Quality of Life
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Adult
Male
Cancer Research
medicine.medical_specialty
Randomization
Adenocarcinoma
03 medical and health sciences
Random Allocation
0302 clinical medicine
Unresected
Gastrectomy
Surgical oncology
Stomach Neoplasms
medicine
Humans
Gastric cancer surgery
Postoperative Period
Lymph node
Aged
Randomized Controlled Trials as Topic
Aged
80 and over
Upfront randomization
business.industry
Gastroenterology
Induction chemotherapy
Cancer
General Medicine
Middle Aged
medicine.disease
Surgery
Treatment Outcome
medicine.anatomical_structure
Oncology
Chemotherapy
Adjuvant
030220 oncology & carcinogenesis
Female
Radiotherapy
Adjuvant
030211 gastroenterology & hepatology
Original Article
business
Chemoradiotherapy
Abdominal surgery
Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Surgical quality
Zdroj: Claassen, Y H M, Hartgrink, H H, de Steur, W O, Dikken, J L, van Sandick, J W, van Grieken, N C T, Cats, A, Trip, A K, Jansen, E P M, Kranenbarg, W M M-K, Braak, J P B M, Putter, H, van Berge Henegouwen, M I, Verheij, M & van de Velde, C J H 2019, ' Impact of upfront randomization for postoperative treatment on quality of surgery in the CRITICS gastric cancer trial ', Gastric Cancer, vol. 22, no. 2, pp. 369-376 . https://doi.org/10.1007/s10120-018-0875-1
Gastric Cancer, 22, 369-376
Gastric Cancer, 22(2), 369-376. Springer Japan
Gastric cancer, 22(2), 369-376. Springer Japan
Gastric Cancer
Gastric Cancer, 22, 2, pp. 369-376
Gastric Cancer, 22(2), 369-376
ISSN: 1436-3291
DOI: 10.1007/s10120-018-0875-1
Popis: Contains fulltext : 203168.pdf (Publisher’s version ) (Open Access) BACKGROUND: Preoperative randomization for postoperative treatment might affect quality of surgery. In the CRITICS trial (ChemoRadiotherapy after Induction chemotherapy In Cancer of the Stomach), patients were randomized before treatment to receive chemotherapy prior to a D1 + gastrectomy (removal of lymph node station (LNS) 1-9 + 11), followed by either chemotherapy (CT) or chemoradiotherapy (CRT). In this analysis, the influence of upfront randomization on the quality of surgery was evaluated. METHODS: Quality of surgery was analyzed in both study arms using surgicopathological compliance (removal of >/= 15 lymph nodes), surgical compliance (removal of the indicated LNS), and surgical contamination (removal of LNS that should be left in situ). Furthermore, the 'Maruyama Index of Unresected disease' (MI) was evaluated in both study arms, and validated with overall survival. RESULTS: Between 2007 and 2015, 788 patients with gastric cancer were included in the CRITICS study of which 636 patients were operated with curative intent. No difference was observed between the CT and CRT group regarding surgicopathological compliance (74.8% vs 70.9%, P = 0.324), surgical compliance (43.2% vs 39.2%, P = 0.381), and surgical contamination (59.4% vs 59.9%, P = 0.567). Median MI was 1 in both groups (range CT 0-88 and CRT 0-136, P = 0.700). A MI below 5 was associated with better overall survival (CT: P = 0.009 and CRT: P = 0.013). CONCLUSION: Surgical quality parameters were similar in both study arms in the CRITICS gastric cancer trial, indicating that upfront randomization for postoperative treatment had no impact on the quality of surgery. A Maruyama Index below five was associated with better overall survival.
Databáze: OpenAIRE
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