Annals of Surgical Oncology

, Volume 24, Issue 12, pp 3658–3666 | Cite as

Endoscopic Ultrasound as a Pretreatment Clinical Staging Tool for Gastric Cancer: Association with Pathology and Outcome

  • Ryan P. Merkow
  • Gabriel Herrera
  • Debra A. Goldman
  • Hans Gerdes
  • Mark A. Schattner
  • Arnold J. Markowitz
  • Vivian E. Strong
  • Murray F. Brennan
  • Daniel G. Coit
Gastrointestinal Oncology



Endoscopic ultrasound (EUS) is a guideline-recommended diagnostic test to estimate pretreatment clinical stage in gastric cancer. The impact of EUS to discriminate long-term outcomes has not been established.


The objectives of our study were to (1) evaluate the association between EUS and pathologic stage; (2) evaluate the ability of EUS to predict disease-specific survival (DSS); and (3) determine how neoadjuvant chemotherapy (NCT) affects these relationships.


A prospective gastric cancer database at a tertiary care cancer center identified 734 patients who underwent curative intent resection. Patients were separated into EUS low-risk (T1–2, N0) and EUS high-risk (T3–4 Nany, or Tany N+) groups. Agreement statistics and 5-year DSS were estimated stratified by NCT.


Between 1987 and 2015, 68% (502/734) of patients were not treated with NCT. Among these patients, percentage agreement between EUS and pathology was moderate (individual T stage: 52%; N stage: 70%; risk group: 73%). EUS accurately estimated pathologic risk group in 73% (365/502) of patients, whereas it overestimated pathologic risk group in 19% (93/502) of patients and underestimated risk in 8% (41/502) of patients. EUS in non-NCT staging was able to discriminate DSS for T stage (hazard ratio [HR] 5.07, p < 0.05), N stage (HR 3.58, p < 0.05), and risk group (HR 6.35, p < 0.05). Among patients treated with NCT, EUS was unable to discriminate DSS for T stage (HR 0.94, p > 0.05), N stage (HR 1.46, p > 0.05) and risk group (HR 0.50, p > 0.05).


Pretreatment clinical staging based on EUS alone could lead to over- or under treatment in 27% of patients and can discriminate DSS in NCT-naive patients. EUS should be used in the context of other validated clinical risk tools.



This study was supported in part by National Institutes of Health/National Cancer Institute (NIH/NCI) Grant P30 CA008748 (Cancer Center Support Grant).


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Copyright information

© Society of Surgical Oncology 2017

Authors and Affiliations

  • Ryan P. Merkow
    • 1
  • Gabriel Herrera
    • 1
  • Debra A. Goldman
    • 2
  • Hans Gerdes
    • 3
  • Mark A. Schattner
    • 3
  • Arnold J. Markowitz
    • 3
  • Vivian E. Strong
    • 1
  • Murray F. Brennan
    • 1
  • Daniel G. Coit
    • 1
  1. 1.Department of SurgeryMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Epidemiology and BiostatisticsMemorial Sloan Kettering Cancer CenterNew YorkUSA
  3. 3.Gastroenterology and Nutrition ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA

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